Perspective - (2022) Volume 12, Issue 2
Patients with Alzheimer disease may exhibit neuropsychiatric symptoms due to their language backgrounds in early life
Corresponding Author:Marcellino Coppola
Developmental Neurology Unit, IRCCS Foundation Carlo Besta Neurological Institute, Celoria 11, Milan, Italy
Received date:02-Feb-2022,Manuscript No.NPY-22-57981;
Editor assigned date:04-Feb-2022,PreQC No. NPY-22-57981(PQ);
Reviewed date:15-Feb-2022,QC No NPY-22-57981;
Revised date:25-Feb-2022,Manuscript No. NPY-22-57981(R);
Published date:04-Mar-2022,DOI: 10.37532/1758-2008.2022.12(2).629
The core symptoms ofAlzheimer's disease are Neuropsychiatric Symptoms (NPSs), which can bepsychotic (delusions and hallucinations), affective (apathy, depressed mood,irritability, and anxiety), or behavioural (euphoria, disinhibit ion,agitation, aberrant motor activities, sleep disturbance, and eating disorder).NPSs were originally assumed to appear in persons who were at the end of theirlives. However, it is now known to present in prodromal and all stages ofAlzheimer's disease. NPSs are also linked to early institutionalisation,caregiver anxiety, and rapid cognitive deterioration. In a recent study, theprevalence of NPSs in patients with Alzheimer's disease was estimated to be at30%-40%, with an annual incidence of 20%-30%. If untreated Alzheimer's patientsare included, the prevalence of NPSs could be as high as 77.8%.
Many biologicalcharacteristics, such as age, sex, race, disease severity, and general medicalstate, have been proposed as risk factors for NPSs. In most research, theseverity of dementia has been consistently linked to NPSs. However, the resultsof studies on these biological risk variables have been equivocal, if notdownright conflicting at times. Studies have focused on environmental orpsychosocial effects on individuals in addition to biological risk factors.Biological and environmental consequences have been identified in certainstudies. Depression was substantially more common in cognitively impaired ChineseAmericans than in cognitively impaired Caucasians, according to a study thatincluded 137 elderly Chinese Americans and 140 Caucasians with and withoutcognitive impairment from a referral memory clinic.
Furthermore, ChineseAmericans were less likely than Caucasians to be receiving depressiontreatment. In that instance, depression is linked to both biological andenvironmental factors, such as ethnicity and education and culture. Fewresearch, however, have looked into the relationship between early languageexperience and NPSs in dementia.
Aside from NPSs,Alzheimer's disease affects patients' cognitive function in a variety of ways.One of the earliest and most prevalent signs is a loss of language. Itfrequently causes communication issues and puts a strain on caretakers.According to studies, persons with Alzheimer's disease may seek to employchildhood languages or even neologisms as a result of their linguisticdifficulties.
Many Taiwanese peoplereceived official Japanese education as children prior to World War II (WW II).As a result, unlike their Taiwanese contemporaries who earned their educationafter the war or on the mainland, these Taiwanese people can communicate inJapanese. Japanese was also their first symbolic language. Taiwan's officiallanguage was converted to Mandarin Chinese after the war. As a result,Taiwanese people who received formal Japanese education maintained a low degreeof fluency in Japanese. Most members of this group still speak Taiwanese orMandarin Chinese in everyday life.
We recruited 21individuals with Alzheimer's disease from a memory clinic in a previous pilottrial. We discovered that multilingual Alzheimer's patients had higherdelusions. Furthermore, delusions are thought to be caused by "linguisticmixing" and "wrong emotional response." This study investigatedthis notion further by employing a more complete design and a large sample sizecohort.
According to thefindings of this study, Taiwanese patients with Alzheimer's disease who gotJapanese education as a child may have higher NPSs than those who did not. Thelink was stronger among patients with Alzheimer's disease who had a pooreducational level. The differences in NPSs between these two groups werelimited to hallucination, depression, and anxiety. Simultaneously, wediscovered that individuals with Alzheimer's disease who had had Japaneseschooling had lower language-related MMSE sub-item scores than theirnon-Japanese peers.
The effects of"linguistic mixing," which we demonstrated in a prior pilot study,can be related to the findings of our investigation. In their childhood, ourparticipants had received official Japanese education for about 6 years.Despite the fact that Japanese was their first symbolic language, they spentthe majority of their time speaking Taiwanese or Mandarin Chinese. To put itanother way, they were mostly unbalanced multilingual. When they got dementia,each language may not have devolved at the same time, and they tended toconverse with others using a mixture of languages. More misunderstanding andimproper emotional responses may have resulted as a result.
In a prior study, weused various real-life examples to highlight this tendency. In the currentstudy, we discovered that communication challenges may have caused increaseddelusion, depression, and anxiety in our Alzheimer's patients. Delusions havebeen linked to early life experience, and the combination of these behaviouralsymptoms has been documented in dementia patients with decreased language function.
Chronic stress in thisgroup of persons with distinct life circumstances could perhaps be a factor inour findings. Taiwan's official language was converted from Japanese toMandarin Chinese after WWII. As a result, persons who had received a Japanese educationwere largely isolated and had fewer career and educational prospects. Chronicstress has been identified as a risk factor for Alzheimer's disease, with thepotential to increase the incidence or speed up the onset of the disease. In apopulation-based sample followed for 35 years, patients with more self-reportedpsychological stress in midlife acquired AD in late age, according to alongitudinal study.
Inflammation andglucose metabolism were employed to elucidate the underlying process in animal research.More NPSs, according to our findings, should be viewed as an early and criticalindicator of potential rapid cognitive impairment.
The GDS (self-reported)did not reveal that the patients were more depressed than another group ofpeople in this study; nevertheless, the sub-item analysis of the NPI-Q(completed by their family or carers) indicated that the patients were moredepressed. There was a disparity between the two scores. This gap could be dueto a disconnect between their perception of themselves and their perception oftheir family or carer.