Papers by sergio starkstein
The use of general descriptive names, registered names, trademarks, service marks, etc. in this p... more The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.
Frontiers in Psychiatry, 2021
Alzheimer's & dementia (Amsterdam, Netherlands), 2017
Poor insight about their cognitive and functional deficits is highly prevalent in patients with A... more Poor insight about their cognitive and functional deficits is highly prevalent in patients with Alzheimer's disease (AD); however, there is a lack of reliable, valid instrumentation to measure this construct. The aim of this study was to develop and validate a semistructured interview to assess insight and judgment in patients with AD and to provide information regarding the assessment of competency and risk in this population. We validated the Structured Clinical Interview for Insight and Judgment in Dementia (SIJID) in a consecutive series of 124 patients with probable AD. The following psychometric properties were evaluated: internal consistency, test-retest reliability, interrater reliability, and convergent and predictive validity. The SIJID demonstrated high test-retest, interrater reliability and also showed strong discriminant and convergent validity. It showed good predictive validity based on 1-year follow-up information of the patient's clinical outcomes, with a s...
The American Journal of Geriatric Psychiatry, 2009
Objectives: Parkinsonian signs are frequent in Alzheimer disease (AD) and are associated with a f... more Objectives: Parkinsonian signs are frequent in Alzheimer disease (AD) and are associated with a faster cognitive decline, worse quality of life, and early nursing home admission. Cross-sectional studies in AD reported a significant association between parkinsonism and apathy. The aim of this study was to assess the chronological association between apathy and parkinsonism in AD. Design: Longitudinal study of a consecutive series of patients with AD. Setting: Dementia clinic from a tertiary clinical center. Participants: One hundred sixty-nine patients meeting diagnostic criteria for AD. Intervention: A consecutive series of 169 patients with probable AD were assessed for the presence of parkinsonism, cognitive deficits, apathy, and depression with the Unified Parkinson's Disease Rating Scale and a comprehensive neuropsychiatry assessment. One hundred thirty-six (80%) of the patients had a follow-up assessment between 1 and 4 years after the baseline evaluation. Measurements: Scores on apathy, parkinsonism, and depression scales at follow-up were the main outcome measures. Results: Patients with apathy at baseline or those who developed apathy during follow-up had a significant increase in parkinsonism at follow-up when compared with patients with no apathy at both assessments. The association between apathy and increasing parkinsonism was unrelated to age, gender, the severity of cognitive deficits, the presence of depression, or use of psychotropic medications. On the other hand, neither the presence of parkinsonism nor depression at baseline was significantly associated with more severe apathy at follow-up. Conclusion: Apathy may be an early manifestation of a more aggressive AD phenotype characterized by loss of motivation, increasing parkinsonism, a faster cognitive and functional decline, and more severe depression.
Specificity of symptoms of depression in Alzheimer disease: a longitudinal analysis
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, 2005
Authors examined the temporal stability of symptoms of major and minor depression and apathy in d... more Authors examined the temporal stability of symptoms of major and minor depression and apathy in dementia. A consecutive sample of 65 patients with Alzheimer disease (AD) and depression at baseline evaluation received a follow-up psychiatric assessment that included the Structured Clinical Interview for DSM-IV and the Hamilton Rating Scale for Depression an average of 17 months later. Half of the sample had no depression at follow-up, and showed a significant improvement in sadness, guilt, suicidal ideation, disruption in sleep, loss of interest, loss of energy, thoughts of death, social withdrawal, psychomotor changes, changes in appetite/weight, and symptoms of anxiety. No significant changes were found on scores of irritability or apathy. The study demonstrates the specificity of depressive symptoms in AD and suggests that apathy and depression are different behavioral domains.
Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2010
We will review the available evidence on the frequency, clinical correlates, mechanism, and treat... more We will review the available evidence on the frequency, clinical correlates, mechanism, and treatment of apathy following stroke. We have explored relevant databases (that is, PubMed, MEDLINE, and PsycINFO) using the following key words and their combinations: apathy, motivation, abulia, stroke, cerebrovascular disease, basal ganglia, prefrontal cortex, anterior cerebral infarction, and thalamus. The frequency of apathy following stroke has been consistently estimated between 20% and 25%. It appears to be associated with the presence of cognitive impairment, a chronic course characterized by progressive functional decline, and with disruption of neural networks connecting the anterior cingulate gyrus, the dorsomedial frontal cortex, and the frontal pole with the ventral aspects of the caudate nucleus, the anterior and ventral globus pallidus, and the dorsomedian and intralaminar thalamic nuclei. Published treatment studies have been mostly limited to anecdotal case reports, generall...
Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2010
To review the frequency, clinical correlates, and mechanism of anosognosia after stroke. We searc... more To review the frequency, clinical correlates, and mechanism of anosognosia after stroke. We searched the most recent relevant literature on anosognosia after stroke and carried out a critical analysis of the main findings. Anosognosia is present in about 10% of acute stroke patients and its diagnosis is relatively simple. Nevertheless, a valid and reliable standardization of diagnostic instruments and criteria for research purposes is more difficult to achieve. This limitation may partially account for various instruments available to assess anosognosia and the different strategies used to diagnose this phenomenon. Anosognosia is a fleeting phenomenon and chronic cases are infrequent. There is a robust association between anosognosia and right-hemisphere lesions involving cortical (insular, temporal, and parietal lobes) and subcortical structures (thalamus and basal ganglia). The main clinical correlates of anosognosia are the presence of neglect, cognitive deficits, previous stroke...
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, Jan 2, 2014
To determine the prevalence, incidence, persistence, likely causes, and consequences of apathy in... more To determine the prevalence, incidence, persistence, likely causes, and consequences of apathy in patients with Type 2 diabetes and to compare the prevalence with a healthy control sample. Cross-sectional comparison of diabetic and nondiabetic samples; longitudinal follow-up of diabetic sample. Academic research department. Non-demented, older patients with long-standing Type 2 diabetes (N = 122) recruited from a community-based cohort study and 69 healthy volunteers. Clinical assessments of apathy and potential causative conditions, repeated in the diabetic sample after 16.7 ± 2.5 months. Informant rated symptoms from the 14-item Apathy Scale were used to generate apathy diagnoses based on standardized criteria. Cognition was assessed by Mini-Mental State Examination (MMSE) and Clinical Dementia Rating (CDR). The diabetic and comparison samples had the same age and MMSE scores, but the diabetic sample had a higher frequency of depression, cerebrovascular history, and cognitive defi...
Neuropsychiatry, 2011
Depression is among the most common psychiatric disorders in Alzheimer's disease (AD). Neverthele... more Depression is among the most common psychiatric disorders in Alzheimer's disease (AD). Nevertheless, given the overlap between the symptoms of depression and the symptoms of dementia, diagnosing depression is still problematic. Several depression rating scales have been validated for use in AD. Both the Hamilton Depression Rating Scale and the Montgomery-Asberg Depression Rating Scale have been used for screening purposes, to measure the severity of depression, and for assessing response to treatment. The recommendation to diagnose depression in AD is by using structured psychiatric interviews, such as the Structured Clinical Diagnostic Interview for DSM-IV or the Mini International Neuropsychiatric Interview. Based on information obtained from the structured interviews, depression is diagnosed using DSM-IV criteria. Consensus groups suggested specific changes to the diagnostic criteria to account for the overlap of symptoms between depression and dementia, and recent studies validated the DSM-IV criteria for major depression for use in AD.
Psychiatry of Parkinson's Disease, 2012
Depression and anxiety disorders are among the most common psychiatric comorbidities in Parkinson... more Depression and anxiety disorders are among the most common psychiatric comorbidities in Parkinson's disease (PD). Most patients will suffer major depression, minor depression or dysthymia at some stage during the progression of the illness. The presence of major depression suggests a more malignant type of PD as it is associated with a faster cognitive and functional decline, and a faster progression along the stages of the illness. Recent studies suggest some antidepressants, and the dopamine agonist pramipexole may be useful to treat depression in PD. Given the paucity of valid instruments to measure anxiety in PD, its frequency and clinical correlates are less well known. Future studies will focus on separating the generic anxiety disorders, such as generalized anxiety disorder and social phobia, from the anxiety symptoms that may be idiosyncratic to the motor symptoms of PD, such as 'off' period anxiety. Specific psychotherapeutic techniques are currently being developed to treat depression and anxiety in PD.
Stroke, 1988
We followed 16 patients who developed depression immediately after a stroke for 6 months. By that... more We followed 16 patients who developed depression immediately after a stroke for 6 months. By that time, six patients showed no depression (recovered group), while 10 patients were still depressed (nonrecovered group). There were no significant differences in demographic variables and social functioning between the groups, but the nonrecovered group showed less improvement in cognitive function and more physical impairments. Patients in the nonrecovered group had mainly cortical lesions, while those in the recovered group had mainly subcortical and posterior circulation strokes.
Journal of Neurosurgery, 1994
✓ The authors examine those factors that contributed to deterioration in social functioning, acti... more ✓ The authors examine those factors that contributed to deterioration in social functioning, activities of daily living, or intellectual functioning during a 1-year period after traumatic brain injury (TBI). Fifty-two patients suffering an acute TBI were evaluated for existence and severity of mood disorders and impairment during their hospital stays and at 3-, 6-, and 12-month follow-up examinations. Patients whose scores on intellectual function, social function, or daily activities deteriorated during the 1-year period after trauma were considered to have a poor outcome. Eleven of 52 patients had a poor outcome in social function, which was associated with race, right-hemisphere lesions, intellectual impairment, and prolonged major depression. Seven of 52 patients had a poor outcome in daily activities, which was associated with a major depression of more than 6 months' duration and severity of Hamilton Depression Rating Scale scores. Eleven of these patients had a poor outco...
Journal of Neurology, Neurosurgery & Psychiatry, 1995
This study examined the prevalence and correlates of pathological affect in Alzheimer's disease. ... more This study examined the prevalence and correlates of pathological affect in Alzheimer's disease. A consecutive series of 103 patients with Alzheimer's disease were examined with a comprehensive psychiatric assessment that included the pathological laughing and crying scale (PLACS). Forty patients (39%) showed pathological affect: 25% showed crying episodes, and 14% showed laughing or mixed (laughing and crying) episodes. Patients with pathological affect crying showed significantly higher depression scores and a significantly higher fre- quency of major depression and dys- thymia than patients with no pathological affect. Patients with mixed pathological affect showed significantly more subcor- tical atrophy on CT than patients with pathological affect crying. Forty seven per cent of the patients with pathological affect had no congruent mood disorder, and they showed a significantly longer duration of illness and more severe anosognosia than patients with pathological affect that was congruent with an underlying mood disorder. The study validates the PLACS, and shows the high prevalence of pathological affect in Alzheimer's disease.
Journal of Neurology, Neurosurgery & Psychiatry, 2006
Background: Apathy and depression are the most frequent behavioural and psychiatric disorders in ... more Background: Apathy and depression are the most frequent behavioural and psychiatric disorders in Alzheimer's disease, and may both have a negative impact on the progression of the illness. Objectives: To examine the clinical correlates of apathy in Alzheimer's disease (AD), and to determine whether apathy is a significant predictor of more rapid cognitive, functional and emotional decline. Methods: Using a structured psychiatric evaluation, we examined a consecutive series of 354 subjects meeting clinical criteria for AD. Apathy was assessed by the Apathy Scale, and diagnosed using standardised criteria. Additional measurements included scales for depression, functional impairment, and global cognitive functions. A follow up evaluation was carried out in 247 patients (70% of the total sample) between 1 and 4 years after the baseline evaluation. Results: Apathy was significantly associated with older age (p = 0.009), and a higher frequency of minor and major depression (p,0.0001). Apathy at baseline was a significant predictor of depression at follow up (p = 0.01), and was associated with a faster cognitive (p = 0.0007) and functional decline (p = 0.006). Conclusions: Apathy in AD is a behavioural marker of a more aggressive dementia, characterised by a faster progression of cognitive, functional, and emotional impairment.
Journal of Neurology, Neurosurgery & Psychiatry, 2008
Journal of Neurology, Neurosurgery & Psychiatry, 1994
Eight patients with a clinical diagnosis of probable Alzheimer's disease, eight patients with the... more Eight patients with a clinical diagnosis of probable Alzheimer's disease, eight patients with the clinical diagnosis of frontal lobe dementia, and eight controls were examined with single photon emis- sion tomography (SPECT) using "Tc-HMPAO. Patients with Alzheimer's disease and those with frontal lobe dementia met DSM-III-R criteria for mild dementia and were in the early stages of the iflness. Compared with
Journal of Neurology, Neurosurgery & Psychiatry, 2005
Background: Whereas apathy is increasingly recognised as a frequent abnormal behaviour in dementi... more Background: Whereas apathy is increasingly recognised as a frequent abnormal behaviour in dementia, its overlap with depression remains poorly understood. Aims: To assess the psychometric characteristics of a structured interview for apathy, and to examine the overlap between apathy and depression in dementia. Methods: A total of 150 patients with Alzheimer's disease (AD) underwent a comprehensive psychiatric and cognitive assessment. Results: Twelve per cent of the sample met criteria for both apathy and depression, 7% met criteria for apathy only, and 31% met criteria for depression only. Apathy (but not depression) was significantly associated with more severe cognitive deficits. Apathy and anxiety scores accounted for 65% of the variance of depression scores in dementia, and the diagnosis of apathy had a minor impact on the rating of severity of depression. Conclusions: The Structured Interview for Apathy demonstrated adequate psychometric characteristics. Using a novel structured interview for apathy in AD we demonstrated that whereas the construct of depression primarily consists of symptom clusters of apathy and anxiety, apathy is a behavioural dimension independent of depression.
Journal of Neurology, Neurosurgery & Psychiatry, 1994
The prevalence and clinical correlates of extrapyramidal signs in a consecutive series of 78 pati... more The prevalence and clinical correlates of extrapyramidal signs in a consecutive series of 78 patients with Alzheimer's dis- ease attending a neurology clinic, and 20 age comparable normal controls, were examined. Based on the unified Parkinson's disease rating scale (UPDRS) findings, 18 patients (23%) met criteria for parkinsonism, 44 (56%) had isolated extrapyramidal signs, and 16 (21%) had no extrapyramidal signs. Whereas the control group showed a sim- ilar prevalence of isolated extrapyramidal signs (57%), none of them showed parkinsonism. No significant differences were found for age, sex, duration of illness, and severity of dementia among the three Alzheimer's disease groups. Patients with Alzheimer's diseaseparkinsonism, however, showed a signifi- candy higher frequency of major depression and dysthymia and significandy higher Hamilton depression scores than patients with isolated or no extrapyramidal signs. Patients with Alzheimer's disease-parkinsonism also showed significantly more deficits on frontal lobe related tasks such as the Wisconsin card sorting test, trail making test, and verbal fluency, as well as on tests of constructional praxis and abstract reasoning than patients with Alzheimer's disease but no extrapy- ramidal signs. In conclusion, the study showed a specific association between Alzheimer's disease and parkinsonism, as well as significant relations between parkinsonism, deficits in executive func- tions, and depression among patients with Alzheimer's disease.
Journal of Neurology, Neurosurgery & Psychiatry, 1991
2 Secondary prevention of vascular disease by prolonged antiplatelet treatment-Antiplatelet trial... more 2 Secondary prevention of vascular disease by prolonged antiplatelet treatment-Antiplatelet trialists' collaboration. BMJ 1988;
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Papers by sergio starkstein