***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND While the relationship of apolipoprotein E ( APOE ) to behavioral symptoms of dementia ( BSD ) has been studied in community-dwelling persons with AD , it has received limited attention within the nursing home ( NH ) population . The aim of this study was to examine the association between APOE genotype and  BSD in NH residents using direct observation . METHODS Thirty-six participants , aged 71 - 102 years , were compared using a non-r and omized two-group design with continuous measures . APOE genotype was obtained by buccal swab .  BSD , including restlessness , escape restraint , tapping and banging , search ing and w and ering , pacing and walking , and vocalization  , were measured using the Modified Agitated Behavior Rating Scale . Participants were observed every 20 minutes for 12 hours per day for five days . Each participant 's mean behavior scores were compared according to the presence or absence of the APOE epsilon4 allele . RESULTS Resident characteristics included a mean MMSE of 10.44 indicating moderate to severe dementia and a mean of 3.44 medical co-morbidities . Fifty-six percent of the participants had one epsilon4 allele . A significant difference was found between APOE epsilon4+/4- and mean behavioral scores ( F(1,31 ) ) = 4.40 , p = 0.04 ) . Restlessness was significantly inversely correlated with MMSE ( r = -0.367 , p = 0.03 ) , but not APOE genotype . There was no significant correlation between proxy reporting and direct observation ( r = 0.257 , p = 0.13 ) . CONCLUSION Findings indicate that the presence of the APOE epsilon4 + genotype increases the risk for  BSD in NH residents with dementia . Direct observation proved a more accurate estimate of BSD than proxy report Purpose To identify correlates of  self-rated and caregiver-rated quality of life ( QOL )  in community-residing persons with dementia ( PWD ) for intervention development . Methods Cross-sectional data of 254 PWD and their caregivers participating in a clinical trial were derived from in-home assessment s.  Self-rated QOL  was measured with the  Quality of Life-Alzheimer Disease ( QOL-AD ) scale  , and  caregiver-rated QOL  was measured using the  QOL-AD  and  Alzheimer Disease-Related Quality of Life ( ADRQL ) scales . Multivariate modeling identified correlates of the PWD ’ QOL . Results Self-rated QOL was related significantly to participant race , unmet needs , depression , and total medications . Caregiver-rated QOL-AD scores were significantly associated with participant function , unmet needs , depression , and health problems and with caregiver burden and self-rated health . Significant correlates of ADRQL scores included neuropsychiatric symptom severity , functional and cognitive impairment , and caregiver burden and depression . Conclusions Correlates of QOL in community-residing PWD depend on who rates the PWD ’s QOL and which measure is used . Addressing health problems , medication use , and dementia-related unmet needs , reducing functional dependency , and treating neuropsychiatric symptoms in PWD , while reducing caregiver burden and depression , may maximize QOL in those with dementia Background Psychiatric symptoms occur frequently in the course of AD , are a frequent contributor to institutionalization , predict cognitive decline and death , and often require treatment with psychotropic medications . Previous studies investigating the association between APOE genotype and psychiatric symptomatology in AD have reported contradictory results . Objective To determine whether APOE genotype predicts incident psychiatric symptomatology in patients with AD . Methods Eighty-seven patients with AD at early stages and no psychiatric history were followed semiannually for up to 9.3 years ( mean 5.5 years ) for development of delusions , illusions , hallucinations , behavioral symptoms , and depression . Cox proportional hazards models were used to examine the relative risk for incident psychiatric symptomatology ( outcome ) in relation to APOE genotype ( predictor ) . Results The presence of one & egr;4 allele carried a 2.5-fold risk , whereas the presence of two & egr;4 alleles carried a 5.6-fold risk for development of delusions . The associations remained significant even when age , ethnicity , sex , education , duration of disease , and cognitive and functional performance were controlled for . The presence of two & egr;4 alleles was associated with reduced risk for developing hallucinations in the adjusted analysis only . No significant associations were detected between APOE genotype and the incidence of illusions , behavioral symptoms , or depression . Conclusion The presence of one or more & egr;4 alleles is a significant predictor for the incidence of delusions in the course of AD Objective : The authors aim ed to use baseline data of an ongoing large , prospect i ve study in subjects with mild cognitive impairment ( MCI ) to investigate the impact of APOE genotype on the symptom profile of the condition . Methods : Cognitive assessment s included the AD Assessment Scale cognitive subscale ( ADAS-cog ) , the Mini-Mental State Examination ( MMSE ) , and a cognitive battery for assessment of memory , attention , and executive function . Behavioral assessment s included the  Neuropsychiatric Inventory and Beck Depression Inventory . Activities of daily living were assessed by the  AD Cooperative Study Activities of Daily Living ( ADCS-ADL ) scale . Hippocampal volumes were measured with MRI . Results : A total of 494 of 1,018 study subjects provided APOE data . Approximately 40 % of the subjects were APOE ε4 carriers . APOE ε4 carriers had lower MMSE ( p = 0.01 ) and higher ADAS-cog ( p < 0.0001 ) scores than noncarriers , indicating worse cognitive impairment . APOE ε4 carriers also had greater deficits on New York University delayed paragraph recall and Buschke free and cued selective reminding tests , and on the ADCS-ADL scale ( p < 0.001 ) . They also had smaller hippocampal volumes ( p = 0.002 ) . Behavioral scores were similar across the subgroups . Conclusion : MCI subjects carrying the APOE ε4 allele showed distinct cognitive and imaging profiles , which appeared to resemble those of early Alzheimer patients . APOE ε4 genotype was associated with greater impairments in memory and functional activities as well as hippocampal atrophy OBJECTIVE The authors conducted a prospect i ve cohort study to estimate the risk of incident mild cognitive impairment in cognitively normal elderly ( aged ≥70 years ) individuals with or without neuropsychiatric symptoms at baseline . The research was conducted in the setting of the population -based Mayo Clinic Study of Aging . METHOD A classification of normal cognitive aging , mild cognitive impairment , and dementia was adjudicated by an expert consensus panel based on published criteria . Hazard ratios and 95 % confidence intervals were computed using Cox proportional hazards model , with age as a time scale . Baseline Neuropsychiatric Inventory Question naire data were available for 1,587 cognitively normal persons who underwent at least one follow-up visit . RESULTS The cohort was followed to incident mild cognitive impairment ( N=365 ) or censoring variables ( N=179 ) for a median of 5 years . Agitation ( hazard ratio=3.06 , 95 % CI=1.89 - 4.93 ) , apathy ( hazard ratio=2.26 , 95 % CI=1.49 - 3.41 ) , anxiety ( hazard ratio=1.87 , 95 % CI=1.28 - 2.73 ) , irritability ( hazard ratio=1.84 , 95 % CI=1.31 - 2.58 ) , and depression ( hazard ratio=1.63 , 95 % CI=1.23 - 2.16 ) , observed initially , increased risk for later mild cognitive impairment . Delusion and hallucination did not . A secondary analysis , limited in significance by the small number of study participants , showed that euphoria , disinhibition , and nighttime behaviors were significant predictors of nonamnestic mild cognitive impairment but not amnestic mild cognitive impairment . By contrast , depression predicted amnestic mild cognitive impairment ( hazard ratio=1.74 , 95 % CI=1.22 - 2.47 ) but not nonamnestic mild cognitive impairment . CONCLUSIONS An increased incidence of mild cognitive impairment  was observed in community-dwelling elderly adults who had nonpsychotic psychiatric symptoms at baseline . These baseline psychiatric symptoms were of similar or greater magnitude as biomarkers ( genetic and structural MRI ) in increasing the risk of incident mild cognitive impairment Objective : To investigate the population -based interaction between a biological variable ( APOE & egr;4 ) , neuropsychiatric symptoms , and the risk of incident dementia  among subjects with prevalent mild cognitive impairment ( MCI ) . Methods : We prospect ively followed 332 participants with prevalent MCI ( aged 70 years and older ) enrolled in the Mayo Clinic Study of Aging for a median of 3 years . The diagnoses of MCI and dementia were made by an expert consensus panel based on published criteria , after review ing neurologic , cognitive , and other pertinent data . Neuropsychiatric symptoms were determined at baseline using the Neuropsychiatric Inventory Question naire . We used Cox proportional hazards models , with age as a time scale , to calculate hazard ratios ( HRs ) and 95 % confidence intervals ( CIs ) . Models were adjusted for sex , education , and medical comorbidity . Results : Baseline agitation , nighttime behaviors , depression , and apathy significantly increased the risk of incident dementia . We observed additive interactions between APOE & egr;4 and depression ( joint effect HR = 2.21 ; 95 % CI = 1.24–3.91 ; test for additive interaction , p < 0.001 ) ; and between APOE & egr;4 and apathy ( joint effect HR = 1.93 ; 95 % CI = 0.93–3.98 ; test for additive interaction , p = 0.031 ) . Anxiety , irritability , and appetite/eating were not associated with increased risk of incident dementia . Conclusions : Among prevalent MCI cases , baseline agitation , nighttime behaviors , depression , and apathy elevated the risk of incident dementia . There was a synergistic interaction between depression or apathy and APOE & egr;4 in further elevating the risk of incident dementia The apolipoprotein E ( APOE ) locus on chromosome 19 has been shown to modify risk , and age at onset , of Alzheimer 's disease ( AD ) . The authors hypothesized that the phenotypic expression of different psychiatric symptoms in patients with AD would be associated with variability in APOE locus . Neuropsychiatric and genetic testing of 120 probable AD patients revealed 28 % had major depression , 17 % had minor depression , 30 % had delusions , and 14 % had hallucinations ; 69 % were carriers of at least one APOE E4 allele ( 14 % homozygous E4/E4 , 49 % heterozygous E3/E4 , 6 % heterozygous E2/E4 , 29 % homozygous E3/E3 , 2 % heterozygous E2/E3 ) . Prevalence of the various psychiatric disturbances did not differ significantly in AD patients with different APOE genotypes . Apolipoprotein E does not appear to modify the risk of developing AD-associated psychiatric symptomatology The etiology of behavioral and psychological symptoms of dementia ( BPSD ) is complex , including putative biological , psychological , social and environmental factors . Recent years have witnessed accumulation of data on the association between genetic factors and behavioral abnormalities in Alzheimer disease ( AD ) . In this research paper , our aim is to evaluate the association between the APOE , CYP46 , PRNP and PRND genes and the profile of neuropsychiatric symptoms in Polish subjects with AD and mild cognitive impairment ( MCI ) . We studied 99 patients with AD and 48 subjects with MCI . The presence and profile of BPSD were evaluated at baseline and prospect ively with the  Neuropsychiatric Inventory ( NPI ) .  Patients were dichotomized into those having ever experienced a particular symptom and those who did not over the whole disease period . Genotyping was performed using previously described st and ard protocol s. The prevalence of comorbid behavioral symptoms and the overall level of behavioral burden were significantly greater in AD compared with the MCI group . In AD patients , carrier status of the T allele of the 3′UTR ( untranslated region ) PRND polymorphism was associated with an increased cumulative behavioral load and an elevated risk for delusions , anxiety , agitation/aggression , apathy and irritability/emotional ability . Among MCI subjects , APOE ε4 carriers demonstrated a reduced risk for nighttime behavior change . No other statistically significant genotype-phenotype correlations were observed , including the APOE , CYP46 and PRNP genes . A precise estimation of the exact significance of particular polymorphisms in BPSD etiology requires future studies on large population CONTEXT Little is known about the population -based prevalence of neuropsychiatric symptoms in mild cognitive imp 
    Output:
    
HighlightsAPOE is not associated with affective symptoms in cognitively impaired subjects .
Studies assessing the affect‐APOE relationship show large heterogeneity in design .Contrasting prior findings could not be explained by this variation in study design .
No association was found between the individual symptoms and APOE & egr;4 carriership or zygosity .
For depression and anxiety , only pooled unadjusted estimates showed positive associations with between‐ study heterogeneity , which could be explained by variation in study design , setting and way of symptom assessment .
Conclusions : There is no evidence that APOE & egr;4 carriership or zygosity is associated with the presence of depression , anxiety , apathy , agitation , irritability or sleep disturbances in cognitively impaired subjects .