Antioxidant <i>N</i> ‐acetylcysteine as an intervention for neuropsychiatric symptoms in individuals with vascular mild cognitive impairment
Bibliographic record
Abstract
BACKGROUND: Neuropsychiatric symptoms (NPS) are non-cognitive changes that often co-occur with mild cognitive impairment (MCI) and independently increase the risk of progression to dementia. Of the NPS, apathy is a particularly strong risk factor. Oxidative stress and vascular risk factors of dementia have been implicated together to contribute to neurodegeneration. We previously found that oxidative stress biomarkers in individuals with vascular MCI (vMCI) were associated with apathy, suggesting antioxidants may be potential treatments. Here, we explored the efficacy of antioxidant N-acetylcysteine (NAC) as a treatment for NPS in individuals with vMCI. METHOD: This is a secondary analysis from a double-blind, RCT ("MOVE-IT") that was conducted on exercising older adults with vMCI (cardiovascular diseases and ≥1 SD below the norm in executive function, processing speed, memory, or working memory). Participants were recruited from a cardiac rehabilitation program. Over 24 weeks, participants received either 2400mg of NAC or placebo as treatment. Neuropsychiatric assessments were taken at weeks 0, 12, and 24. The Mild Behavioural Impairment Checklist (MBI-C) was used to capture five main domains of pre-dementia NPS: apathy, emotional dysregulation (ED), impulse control, social inappropriateness, and psychosis. RESULT: All 59 participants (n = 29 NAC, n = 30 Placebo, 69% male, mean[SD]: age=67.6[7.7], BMI=27.4[5.5], MoCA=22.5[3.2]) provided MBI-C data for this analysis. Zero-inflated Poisson mixed models with subject as random effect were used to address the high proportion of participants without NPS and to fit the incremental severity scores in each MBI-C domain. Covariates included age, sex, and number of cardiovascular risk factors (hypertension, coronary artery disease, hypercholesterolemia, dyslipidemia, type-2 diabetes, > 5-year smoking history, obesity). Significant treatment effects over time were observed for apathy (Baseline: 56% apathy+, β[SD] = -1.35[.415], z = -3.26, p = .001) and ED (Baseline: 54% ED+, β[SD] = -.731[.306], z = -2.03, p = .043) scores at week 12. On average, scores decreased more in the NAC group (mean[SD]: apathy = -1.56[3.27], ED = -2.04[4.20]) than in the placebo group (mean[SD]: apathy = -0.296[1.66], ED = -0.481[1.67]) after 12 weeks. No treatment effects were observed for the other domains. CONCLUSION: The findings support NAC as a potential treatment for apathy and emotional dysregulation in individuals with vMCI and at risk of dementia, thereby reducing associated burdens.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".