Cognitive impairments predict the behavioral and psychological symptoms of dementia

Abstract

IntroductionThe purpose of this study was to (1) validate the Thai version of the Neuropsychiatric Inventory Questionnaire (NPI-Q) as a screening tool for behavioral and psychological symptoms of dementia (BPSD), and (2) examine the relationship between cognitive performance and BPSD in an elderly population with amnestic mild cognitive impairment (aMCI) and dementia of Alzheimer’s type (DAT).MethodsOne hundred and twenty participants, comprising 80 aMCI and 40 DAT patients, and their respective caregivers were included in the study. Participants completed the NPI-Q and the Neuropsychiatric Inventory (NPI) within 2 weeks of each other and cognitive performance was primarily assessed using the Montreal Cognitive Assessment (MoCA).ResultsThe Thai NPI-Q had good validity and reliability. Pure exploratory bifactor analysis revealed that a general factor and a single-group factor (with high loadings on delusions, hallucinations, apathy, and appetite) underpinned the NPI-Q domains. Significant negative correlations between the MoCA total score and the general and single-group NPI-Q scores were found in all subjects (aMCI + DAT combined) and DAT alone, but not in aMCI. Cluster analysis allocated subjects with BPSD (10% of aMCI and 50% of DAT participants) into a distinct “DAT + BPSD” class.ConclusionThe NPI-Q is an appropriate instrument for assessing BPSD and the total score is largely predicted by cognitive deficits. It is plausible that aMCI subjects with severe NPI-Q symptoms (10% of our sample) may have a poorer prognosis and constitute a subgroup of aMCI patients who will likely convert into probable dementia.

Distress Symptoms of Old Age and Mild Cognitive Impairment are Two Distinct Dimensions in Older Adults Without Major Depression

“…The subclinical symptom domain differs significantly from the behavioral and psychological symptoms of dementia (BPSD) which may occur in patients with dementia and some subjects with MCI. 56 The latter symptoms domain encompass delusions, hallucinations, agitation/aggression, depression/dysphoria, anxiety, euphoria, apathy/indifference, disinhibition, irritability/lability, aberrant motor behaviour, nocturnal behavioral disturbances, and irregularities in appetite and eating. 56 It should be added that this study excluded subjects with psychosis, either hallucinations or delusions, agitation, euphoria, or aberrant behaviours and thus excluded not only patients with major depression but also subjects with BPSD.…”

“…23 Distress in old age is a common phenomenon and is often linked with a range of physical and psychological symptoms such as stress, anxiety, melancholy, and neuroticism. 56 However, these symptoms do not always indicate major depression, which causes significant distress and impedes daily functioning. 57 Although depression is a frequent psychiatric disorder in a geriatric population and a substantial risk factor for disability and mortality, it is inaccurately diagnosed in nearly half of all instances.…”

“…This is important as some patients with aMCI may show BPSD. 56 All in all, DSOA is a subclinical symptom domain that emphasizes the presence of distress, mild affective symptoms, and increased neuroticism scores and thus reflects mild psychological strain rather than major depression or BPSD.…”

Distress symptoms of old age and mild cognitive impairment are two distinct dimensions in older adults without major depression: effects of adverse childhood experiences and negative life events

“…As such, this is a new construct indicating that mild subjective distress symptoms may occur in part of the older adults independently from major depression. The subclinical symptom domain differs significantly from the behavioral and psychological symptoms of dementia (BPSD) which may occur in patients with dementia and some subjects with MCI 56 . The latter symptoms domain encompass delusions, hallucinations, agitation/aggression, depression/dysphoria, anxiety, euphoria, apathy/indifference, disinhibition, irritability/lability, aberrant motor behaviour, nocturnal behavioral disturbances, and irregularities in appetite and eating 56 .…”

“…Distress in old age is a common phenomenon and is often linked with a range of physical and psychological symptoms such as stress, anxiety, melancholy, and neuroticism 56 . However, these symptoms do not always indicate major depression, which causes significant distress and impedes daily functioning 57 .…”