Towards Defining the Neuroanatomical Basis of Late-Onset Psychiatric Symptoms

Author:

Barker Megan S.1ORCID,Cosentino Stephanie A.123,Fremont Rachel4ORCID,Devanand Davangere P.4,Huey Edward D.134

Affiliation:

1. Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA

2. Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA

3. Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA

4. Division of Geriatric Psychiatry, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA

Abstract

Psychiatric symptoms, including changes in emotional processing, are a common feature of many neurodegenerative disorders, such as Alzheimer’s disease, dementia with Lewy Bodies, frontotemporal dementia, and Huntington’s disease. However, the neuroanatomical basis of emotional symptoms is not well defined; this stands in contrast to the relatively well-understood neuroanatomical correlates of cognitive and motor symptoms in neurodegenerative disorders. Furthermore, psychiatric diagnostic categories, as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Statistical Classification of Diseases and Related Health Problems (ICD), may have limited applicability in patients with late-onset psychiatric symptoms in the context of neurodegenerative disorders. In this clinical review, we suggest that early-onset and late-onset psychiatric symptoms have distinct etiologies, and that late-onset changes in emotional processing are likely underpinned by neurodegenerative disease. Furthermore, we suggest that an improved understanding of the neuroanatomical correlates of emotional changes in neurodegenerative disease may facilitate diagnosis and future treatment development. Finally, we propose a novel clinical approach, in a preliminary attempt to incorporate late-onset emotional symptoms alongside cognitive and motor symptoms into a clinical “algorithm,” with a focus on the neuroanatomy implicated when particular combinations of emotional, cognitive, and motor features are present. We anticipate that this clinical approach will assist with the diagnosis of neurodegenerative disorders, and our proposed schema represents a move towards integrating neurologic and psychiatric classification systems.

Funder

National Institute of Mental Health

National Institute on Aging

Publisher

SAGE Publications

Subject

Psychiatry and Mental health,Geriatrics and Gerontology,Neurology (clinical)

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