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Neurobiol Aging. 2020 Jan;85:74-82. doi: 10.1016/j.neurobiolaging.2019.10.008. Epub 2019 Oct 19.

Apathy and anxiety are early markers of Alzheimer's disease.

Author information

1
Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Division of Clinical Sciences Helsingborg, Department of Clinical Sciences Lund, Lund University, Helsingborg, Sweden; Department of Psychiatry, Helsingborg Hospital, Helsingborg, Sweden. Electronic address: maurits.johansson@med.lu.se.
2
Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Memory Clinic, Skåne University Hospital, Malmö, Sweden.
3
Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Huddinge, Sweden.
4
Division of Clinical Sciences Helsingborg, Department of Clinical Sciences Lund, Lund University, Helsingborg, Sweden; Department of Internal Medicine, Sahlgrenska Academy, University of Gothenburg, PO SU Sahlgrenska, Göteborg, Sweden.
5
Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Image and Function, Skåne University Hospital, Lund, Sweden.
6
Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Neurology, Skåne University Hospital, Lund Sweden; Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden.
7
Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Memory Clinic, Skåne University Hospital, Malmö, Sweden. Electronic address: oskar.hansson@med.lu.se.

Abstract

In this study, we investigated associations between neuropsychiatric symptoms (i.e., apathy, anxiety, and depression) and cerebral atrophy, white matter lesions (WML), beta-amyloid (Aβ) deposition, and cognitive decline in a nondemented sample. 104 cognitively unimpaired and 53 subjects with mild cognitive impairment were followed for up to 4 years within the Swedish BioFINDER study. Neuropsychiatric assessments included the Hospital Anxiety and Depression Scale and the Apathy Evaluation Scale. Magnetic resonance imaging and 18F-flutemetamol-positron emission tomography quantified brain atrophy, WML, and Aβ deposition. Mini-Mental State Examination assessed longitudinal global cognition. Regression analyses were used to test for associations. Apathy and anxiety were shown related to Aβ deposition and predicted cognitive decline. Anxiety also interacted with amyloid status to predict faster cognitive deterioration. Apathy was further related to frontotemporal and subcortical atrophy, as well as WML. To conclude, the associations between apathy and anxiety with Aβ deposition and cognitive decline point to these symptoms as early clinical manifestations of Alzheimer's disease.

KEYWORDS:

Alzheimer's disease; Amyloid; Anxiety; Apathy; Imaging; White matter lesions

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