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Open Access Publications from the University of California

Scholarly Works (76 results)

  • Article
  • Peer Reviewed
UC San Diego Previously Published Works (2019)
    • Article
    • Peer Reviewed
    UC San Diego Previously Published Works (2016)
      • Thesis
      • Peer Reviewed
      UC San Diego Electronic Theses and Dissertations (2017)

      Rationale: Presently, there are over 5 million Americans living with Alzheimer’s disease (AD); this number is projected to grow to over 7 million by 2025. In the absence of effective treatments, and difficulty reversing the neuropathological changes once they emerge, finding modifiable risk factors early in the course of the disorder is one of the most promising strategies to delay or prevent the progression of predementia [i.e., Mild Cognitive Impairment (MCI)] and dementia syndromes. Two factors that may be particularly important in influencing phenotype and rate of progression to MCI and AD are neuropsychiatric and cardiovascular symptoms.

      Design: This study included 549 cognitively normal, MCI, and AD volunteers from the UC San Diego Alzheimer’s Disease Research Center (ADRC). Participants were seen annually and underwent a one-hour neurological examination, comprehensive neuropsychological testing, ApoE genotyping, and assessments of cardiovascular symptoms, medication use and neuropsychiatric functioning. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals. Separate analogous models were conducted for individuals that converted to MCI and individuals that converted to AD and ApoE-e4 interaction terms were tested. Multilevel modeling analyses were performed separately for cognitively normal, MCI, and AD subgroups to identify any differential sensitivity among neuropsychological domains most sensitive to neuropsychiatric and vascular risk factors across time.

      Results: There were 22 individuals that converted to MCI and 57 individuals that converted to AD during the course of the study. Apathy at baseline was found to significantly increase the risk of MCI after adjusting for age, sex, and education. Individuals endorsing agitation were more than two times as likely to convert to AD and individuals with at least mild depression were 2.5 times as likely to convert to AD. There were no significant interactions between neuropsychiatric symptoms and APoE-e4; cardiovascular risk factors did not predict change in cognitive status. Within-person increases in depressive symptoms were significantly related to decreases on memory and executive functioning among cognitively normal individuals; within-person increases in neuropsychiatric symptoms among AD patients were associated with worse attention, language, visuospatial skills, and processing speed. Moreover, AD patients with higher levels of neuropsychiatric symptoms across time had worse executive functioning relative to AD patients with lower levels of neuropsychiatric symptoms.

      Conclusions: Results suggest that apathy, and agitation and depression at baseline are associated with increased risk of future MCI and AD, respectively. As such, clinicians should monitor individuals presenting with both cognitive complaints and new neuropsychiatric symptoms closely, as these individuals may be at higher risk of developing MCI or AD. This study also found that higher reports of neuropsychiatric symptoms in cognitively normal and AD patients were associated with worse performance across time in specific cognitive domains. Additional studies are warranted that investigate whether treatments designed to improve neuropsychiatric symptoms result in subsequent improvements in specific areas of cognition.

        Cover page: Neuropsychiatric and Cardiovascular Risk Factors Along the Alzheimer’s Disease Continuum
        • Article
        • Peer Reviewed
        UC San Diego Previously Published Works (2021)
          Creative Commons 'BY-NC-ND' version 4.0 license
          • Article
          • Peer Reviewed
          UC San Diego Previously Published Works (2017)
          "Therapeutic misconception" (TM) refers to inappropriate assumptions and beliefs on the part of research participants regarding key distinctions between the purpose, methods, intended benefits, and potential disadvantages of research compared to those of clinical care. Despite an extensive literature describing TM across varied types of research and populations, minimal work has addressed TM in the context of dementia research. This is a serious gap, for several reasons: people with dementia are at significant risk of diminished capacity; surrogate decision makers are typically asked to provide consent on behalf of the person with dementia; and available treatments for dementia are quite limited. More research is needed on the prevalence, nature, and impact of TM in the context of clinical dementia research.
            • Article
            • Peer Reviewed
            UC San Diego Previously Published Works (2016)
            It is often necessary for neuropsychologists, clinical psychologists, and other healthcare professionals to assess an individual's capacity to consent to treatment related to healthcare. This task can be challenging and requires a delicate balance of both respect for individuals' autonomy, as well as the protection of individuals with diminished capacity to make an autonomous decision. The purpose of the present review is to provide an overview of the conceptual model of decisional capacity as well as a brief summary of some of the currently available instruments designed to help evaluate medical decision making. In addition, current empirical literature on the relationship between neuropsychological abilities and decision-making capacity is discussed and a brief set of recommendations is provided to further aid clinicians or consultants when they are required to complete the ethically important but difficult task of making determinations about healthcare decision-making capacity.
              • Article
              • Peer Reviewed
              UC San Diego Previously Published Works (2016)
                • Article
                • Peer Reviewed
                UC San Diego Previously Published Works (1996)
                A review of literature on the neurodevelopmental origins of schizophemia is presented, with particular attention to neurodevelopmental processes in late-onset schizophemia. Definitions of the term "neurodevelopmental" as used in schizophernia literature are first provided. Next, evidence for the developmental origins of the neuropathology in schizophemia is reviewed. This evidence includes studies of the associations between schizophemia and neurodevelopmental brain aberrations, minor physical anomalies, obstetric complications, prenatal viral exposure, childhood neuromotor abnormalities, and pandysmaturation. A brief discussion of the predominant theories about the neurodevelopmental origins of schizophemia is then provided. The concept and nature of "late-onset schizophenia "is next defined and discussed. Finally, the neurodevelopmental literature is discussed in relation to the phenomenon of late-onset schizophemia. Based on this review, we conclude that there exists a strong likelihood that late-onset schizophrenia involves neurodevelopmental processes.
                  Cover page: Neurodevelopmental theories of schizophernia : application to late-onset schizophernia.
                  • Article
                  • Peer Reviewed
                  UC San Diego Previously Published Works (2009)
                  Application of a neuropsychological perspective to the study of schizophrenia has established a number of important facts about this disorder. Some of the key findings from the existing literature are that, while neurocognitive impairment is present in most, if not all, persons with schizophrenia, there is both substantial interpatient heterogeneity and remarkable within-patient stability of cognitive function over the long-term course of the illness. Such findings have contributed to the firm establishment of neurobiologic models of schizophrenia, and thereby help to reduce the social stigma that was sometimes associated with purely psychogenic models popular during parts of the 20th century. Neuropsychological studies in recent decades have established the primacy of cognitive functions over psychopathologic symptoms as determinants of functional capacity and independence in everyday functioning. Although the cognitive benefits of both conventional and even second generation antipsychotic medications appear marginal at best, recognition of the primacy of cognitive deficits as determinants of functional disability in schizophrenia has catalyzed recent efforts to develop targeted treatments for the cognitive deficits of this disorder. Despite these accomplishments, however, some issues remain to be resolved. Efforts to firmly establish the specific neurocognitive/neuropathologic systems responsible for schizophrenia remain elusive, as do efforts to definitively demonstrate the specific cognitive deficits underlying specific forms of functional impairment. Further progress may be fostered by recent initiatives to integrate neuropsychological studies with experimental neuroscience, perhaps leading to measures of deficits in cognitive processes more clearly associated with specific, identifiable brain systems.
                    Cover page: What Do We Know About Neuropsychological Aspects Of Schizophrenia?
                    • Peer Reviewed
                    UC San Diego Previously Published Works (2019)
                      Cover page: Positive Psychiatry for Schizophrenia and Other Psychotic Disorders
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