Behavioural and psychological symptoms in the older population without dementia - relationship with socio-demographics, health and cognition

Abstract

BackgroundBehavioural and psychological symptoms are associated with dementia, but are also present in a significant number of the older population without dementia. Here we explore the distribution of behavioural and psychological symptoms in the population without dementia, and their relationship with domains and severity of health and cognitive impairment.MethodsThe Medical Research Council Cognitive Function and Ageing Study is a two-phase longitudinal study of ageing representative of the population aged 65 and over of England and Wales. A subsample of 1781 participants without a study diagnosis of dementia was included in this study. Information on symptoms including depression, apathy, anxiety, feelings of persecution, hallucination, agitated behaviour, elation, irritability, sleep problems, wandering, confabulation and misidentification, cognitive function, health related factors and socio-demographic information was extracted from interviews with participants and knowledgeable informants. Participants were classified according to the Mini-Mental State Examination and by criteria for subtypes of mild cognitive impairment (MCI). The prevalence of behavioural and psychological symptoms and associations with cognitive function, health and socio-demographics was examined. Co-occurrence of symptoms was tested using factor analysis.ResultsMost symptoms were reported more frequently in those with more severe cognitive impairment. Subjective memory complaints were the strongest independent predictor of reported symptoms, and most were reported more often in those classified as having MCI than in those with cognitive impairments that did not meet the MCI criteria. The pattern of co-occurrence of symptoms is similar to that seen in dementia.ConclusionsOur results highlight that behavioural and psychological symptoms are prevalent in the cognitively impaired older population, and partly explain the variation observed in previous cohorts of individuals with MCI. Behavioural and psychological symptoms offer a target for intervention and so are an important consideration in the assessment of cognitively impaired older people.

Subjective Memory Complaints are Involved in the Relationship between Mood and Mild Cognitive Impairment

“…Symptoms of depression at follow-up were significantly associated with a change in cognitive status from not cognitively impaired to a classification of MCI over two years, but symptoms of anxiety at follow-up did not show such an association. The finding that people classified as having MCI have increased odds of experiencing symptoms of anxiety or depression compared to people without cognitive impairment is in line with the previous literature which has suggested that anxiety and depression are common comorbidities of MCI (Kruger et al, 2012;Ravaglia et al, 2008;Van der Linde, Stephan, Matthews, Brayne, & Savva, 2010). However, the odds of having symptoms of anxiety or depression are not increased in people classified as MCIW.…”

“…The criteria used to create the MCI classification here are consistent with established definitions of MCI (Petersen, 2004;Petersen et al, 2001;Petersen et al, 1999). The procedure for assessment of mood-related symptoms used in this study has also previously been used to produce prevalence calculations for anxiety and depression which are in line with previous research and can be considered to be robust (Van der Linde et al, 2010). Lastly, this study uses a subsample drawn from a larger population sample, which is representative of the older population as participants were not identified through attendance at health services.…”

The Relationship Between Mild Cognitive Impairment and Mood in Older People

“…The finding that people classified as having MCI have increased odds of experiencing symptoms of anxiety or depression compared to people without cognitive impairment is in line with previous literature which has suggested that anxiety and depression are common comorbidities of MCI (Kruger et al, 2012;Ravaglia et al, 2008;Van der Linde et al, 2010).…”

“…Anxiety was found to be the most common neuropsychiatric symptom experienced in a group of people classified as having MCI, with over half reporting symptoms (Gallagher et al, 2011). Depression was reported by 61% of participants in a further study and increased as cognitive function worsened (Van der Linde, Stephan, Matthews, Brayne, & Savva, 2010). Other research has also shown that symptoms of both depression and anxiety increased as memory performance decreased (G. J.…”

Sleep and Cognition

“…Sleep problems are a common occurrence in those with mild cognitive impairment (MCI) [51] and dementia [52]. Those with dementia experience highly fragmented sleep, with frequent daytime napping and night-time periods of wakefulness.…”