Objective: To assess the influence of mild behavioral impairment (MBI) on the cognitive performance of older adults who are cognitively healthy or have mild cognitive impairment (MCI). Methods: Secondary data analysis of a sample (n = 497) of older adults from the Florida Alzheimer’s Disease Research Center who were either cognitively healthy (n = 285) or diagnosed with MCI (n = 212). Over half of the sample (n = 255) met the operationalized diagnostic criteria for MBI. Cognitive domains of executive function, attention, short-term memory, and episodic memory were assessed using a battery of neuropsychological tests. Results: Older adults with MBI performed worse on tasks of executive function, attention, and episodic memory compared to those without MBI. A significant interaction revealed that persons with MBI and MCI performed worse on tasks of episodic memory compared to individuals with only MCI, but no significant differences were found in performance in cognitively healthy older adults with or without MBI on this cognitive domain. As expected, cognitively healthy older adults performed better than individuals with MCI on every domain of cognition. Conclusions: The present study found evidence that independent of cognitive status, individuals with MBI performed worse on tests of executive function, attention, and episodic memory than individuals without MBI. Additionally, those with MCI and MBI perform significantly worse on episodic memory tasks than individuals with only MCI. These results provide support for a unique cognitive phenotype associated with MBI and highlight the necessity for assessing both cognitive and behavioral symptoms.

BackgroundThere has been a shift in research to explore early indicators associated with preclinical/prodromal dementia. Recent research highlights the importance of non‐cognitive factors, such as neuropsychiatric symptoms (NPS), as articulated in criteria for mild behavioral impairment (MBI). Previous research suggests MBI is a risk factor for dementia regardless of if one is cognitively healthy or diagnosed with mild cognitive impairment (MCI). The goal of this study is to examine risk for dementia subtypes based on the presence of MBI and/or MCI.MethodSecondary data analysis of participants (n = 17,289) from the National Alzheimer’s Coordinating Center who were cognitively healthy (n = 11,770) or diagnosed with MCI (n = 5,519). Risk for dementia, Alzheimer’s disease (AD), dementia with Lewy bodies (DLB), and frontotemporal dementia (FTD) were examined using Cox proportional hazard models.ResultAlmost 25% of the entire sample met the operationalized diagnostic criteria for MBI (n = 4,274). The risk for dementia almost tripled among persons with MBI and increased by almost seven‐fold if they had MCI. Among persons with MBI, the risk for FTD was six times greater and the risk for DLB and AD was three times greater, compared to those without MBI. Additionally, for participants who had MCI, the risk for DLB was six times greater, the risk for AD was over nine times greater, and the risk for FTD was almost sixteen times greater, compared to those who were cognitively healthy. There was a significant interaction found between MBI and MCI status. For cognitively healthy older adults with MBI, the risk was almost eleven times greater for FTD, whereas for older adults with MCI and MBI, the risk was three times greater for DLB.ConclusionOlder adults with MBI and MCI are at an increased risk for all types of dementia. Additionally, cognitively healthy participants with MBI are found to have a greater risk for FTD, where participants with MCI and MBI had a greater risk for DLB. These results provide support for MBI as a prodromal state of all‐cause dementia, and highlight the importance of recognizing these symptoms across the spectrum of cognitive decline.

Psychotic phenomena are among the most severe and disruptive symptoms of dementias and appear in 30% to 50% of patients. They are associated with a worse evolution and great suffering to patients and caregivers. Their current treatments obtain limited results and are not free of adverse effects, which are sometimes serious. It is therefore crucial to develop new treatments that can improve this situation. We review available data that could enlighten the future design of clinical trials with psychosis in dementia as main target. Along with an explanation of its prevalence in the common diseases that cause dementia, we present proposals aimed at improving the definition of symptoms and what should be included and excluded in clinical trials. A review of the available information regarding the neurobiological basis of symptoms, in terms of pathology, neuroimaging, and genomics, is provided as a guide towards new therapeutic targets. The correct evaluation of symptoms is transcendental in any therapeutic trial and these aspects are extensively addressed. Finally, a critical overview of existing pharmacological and non-pharmacological treatments is made, revealing the unmet needs, in terms of efficacy and safety. Our work emphasizes the need for better definition and measurement of psychotic symptoms in dementias in order to highlight their differences with symptoms that appear in non-dementing diseases such as schizophrenia. Advances in neurobiology should illuminate the development of new, more effective and safer molecules for which this review can serve as a roadmap in the design of future clinical trials.

Objectives To determine whether music engagement influences middle-aged and older adults’ performance on episodic memory tasks. Methods Secondary data analysis of a sample (N = 4,592) of cognitively healthy adults from the 2016 Health and Retirement Study were used for this study. Multivariable regression models were used to analyze the cross-sectional differences in performance on tasks of episodic memory between participants who listened to music (n= 3,659) or sang or played an instrument (n= 989). Results On average, participants recalled 10.3 words out of a possible 20. Regression analyses showed that both music listening and singing or playing an instrument were independently associated with significantly better episodic memory. Discussion The findings provide the first population-based evidence that music engagement is associated with better episodic memory among middle-aged and older adults. Future studies should examine whether the association is causal or has a dose response.

Background: Mild behavioral impairment (MBI) is considered to be a late life transitional state between normal aging and dementia that describes individuals who have persistent behavioral changes and/or psychiatric symptoms. Individuals with MBI are found to be at greater risk of dementia compared to those without these symptoms. Identifying how MBI might relate to different domains of cognition is of key importance, as it could be an early indicator of a future dementia diagnoses. Method: Secondary data analysis of a sample (n=512) of older adults from the Florida Alzheimer’s Disease Research Center who were either cognitively healthy or presenting with mild cognitive impairment (MCI). Some individuals presented with MBI, as defined by decreased motivation, affective dysregulation, impulse dyscontrol, social inappropriateness, or abnormal perception/thought content. Executive function, attention, short-term memory, and episodic memory, were compared using a battery of neuropsychological assessments. Results: Individuals with MCI performed worse on all tasks across all cognitive domains, where individuals with MBI performed worse on several tasks associated with executive function, attention, and episodic memory. Compared to individuals with only MCI, individuals with MCI and MBI performed significantly worse on tasks associated with executive function and episodic memory. Conclusion: The present study found evidence that individuals with MBI will perform worse on tasks of executive function, attention, and episodic memory. Further, those with MCI and MBI will perform significantly worse on executive function and episodic memory tasks. Future research should explore if these findings can help to predict specific dementia diagnoses.