Mild Behavioral Impairment as a Marker of Cognitive Decline in Cognitively Normal Older Adults

Creese, Byron; Brooker, Helen; Ismail, Zahinoor; Wesnes, Keith; Hampshire, Adam; Khan, Zunera; Megalogeni, Maria; Corbett, Anne; Aarsland, Dag; Ballard, Clive

doi:10.1016/j.jagp.2019.01.215

Cited by 166 publications

(184 citation statements)

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“…The prevalence of MBI (18.2%) in our cognitively normal participants was higher than that reported by Creese (39) in the PROTECT study, in which 10% of community dwelling older adults aged 50 or over (n = 9,931) reported MBI, as captured by the MBI-C. In a clinical sample of Spanish primary care patients who validated the current cut-points, the prevalence was 5.8% in cognitive normal older adults with subjective complaints (20) and 14.2% in MCI (40).…”

Section: Discussioncontrasting

confidence: 83%

Mild behavioral impairment is related to frailty in cognitively normal older adults: a cross-sectional study

Fan

Liang

Yun

et al. 2020

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Background: Frailty and cognitive decline are highly prevalent among older adults. However, the relationship between frailty and mild behavioral impairment (MBI), a neurobehavioral syndrome characterized by later-life emergence of sustained neuropsychiatric symptoms, has yet to be elucidated.We aimed to evaluate the associations between mild behavioral impairment and frailty in cognitively normal older adults.Methods: This is a cross-sectional study. A consecutive series of 137 cognitively normal older adults in the Anti-Aging study, recruited from primary care clinics, were enrolled. Frailty was estimated using the original Fried phenotype. MBI was evaluated by the Mild Behavioral Impairment Checklist at a cut-off point of >8 (optimizing sensitivity and specificity), which was developed to assess emergent neuropsychiatric symptoms in accordance with the MBI criteria. Cognition was assessed with the Chinese versions of the Montreal Cognitive Assessment (MoCA-BC) and Mini-mental State Examination (MMSE). Multivariate logistic regression was performed to estimate the relationship between MBI and objective cognition with frailty status.Results: At baseline, 30.6% of the older adults had frailty, 35.0% had prefrailty and 18.2% had MBI (MBI+ status). Multivariate logistic regression analysis demonstrated that compared to MBI- status (without MBI), MBI+ was more likely to have frailty (odds ratio [OR] = 7.44, p = 0.02). The frailty and MBI categories were both significantly associated with both MMSE and MoCA-BC score (p<0.05).Conclusions: Both frailty and MBI status are related to higher risk of cognitive impairment. MBI is significantly associated with an increased risk of having frailty before overt cognitive impairment. This association merits further study to identify strategies to the early detection, prevention and therapeutic intervention of frailty.

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Section: Discussioncontrasting

confidence: 83%

Mild behavioral impairment is related to frailty in cognitively normal older adults: a cross-sectional study

Fan

Liang

Yun

et al. 2020

Preprint

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“…A recently published 5-year longitudinal study demonstrated a higher rate of incident dementia in MBI compared to late life psychiatric illness, demonstrating the clinical significance of the MBI syndrome, and the importance in distinguishing it from psychiatric illness recurring in late life [15]. Additionally, in a large community sample of cognitively unimpaired participants, MBI demonstrated an associated with faster decline in attention and working memory [16]. Recent genetic evidence has also demonstrated a common etiology between MBI and AD, suggesting that neurodegeneration may contribute to the emergence of neuropsychiatric symptoms, as it does with emergent neurocognitive symptoms [17].…”

Section: Introductionmentioning

confidence: 94%

Prevalence of Mild Behavioral Impairment and Risk of Dementia in a Psychiatric Outpatient Clinic

Matsuoka

Ismail

Narumoto

2019

JAD

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Background: Mild behavioral impairment (MBI) has been proposed as risk factor for dementia, and for some, an early manifestation of dementia. Objective: We examined the prevalence of MBI in the psychiatric outpatient clinic, and compared the incidence of dementia in MBI with that in other psychiatric diseases. Methods: Retrospective chart review was conducted in 2,853 consecutive outpatients over the age of 50. MBI was diagnosed according to the International Society to Advance Alzheimer's Research and Treatment research diagnostic criteria. The incidence rate of dementia was examined in the patients who were followed up for at least 1 month. Kaplan-Meier survival analyses and Cox proportional hazards regression models were performed to compare the time to onset of dementia between MBI and other psychiatric diseases. Results: The prevalence of MBI was 3.5% and the incidence of dementia was 30.7 cases per 1000 person-years. The hazard ratio (HR) for dementia was higher for MBI than other psychiatric diseases (HR: 8.07, 95% confidence interval: 4.34-15.03, p < 0.001). In MCI patients, the cumulative survival in MCI with affective dysregulation tended to be lower than that in MCI without (p = 0.090). Conclusions: Psychiatric outpatients often meet MBI criteria. MBI, especially the affective dysregulation domain, increases the risk of dementia in this psychiatric outpatient population. Since late-onset psychiatric and behavioral symptoms may be prodromal symptoms of dementia in some, careful observation is needed, and psychiatric clinicians should keep prodromal dementia on their differential diagnosis when assessing those with new onset psychiatric symptomatology in older adults.

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“…Using the MBI-C in a primary care population, MBI prevalence was determined to be 5.8% in SCD (Mallo et al, 2018b), and 14.2% in MCI (Mallo et al, 2018a), with cut points of 8.5 and 6.5 respectively demonstrating acceptable sensitivity and specificity for clinically diagnosed MBI according to the ISTAART diagnostic criteria (Mallo et al, 2018b). Subsequent work has shown that the 8.5 cut point is also associated with subtle cognitive decline in healthy older adults (Creese et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Profile of mild behavioral impairment and factor structure of the Mild Behavioral Impairment Checklist in cognitively normal older adults

Creese

Griffiths

Brooker

et al. 2019

Int. Psychogeriatr.

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ABSTRACTObjectives:In this large population study, we set out to examine the profile of mild behavioral impairment (MBI) by using the Mild Behavioral Impairment Checklist (MBI-C) and to explore its factor structure when employed as a self-reported and informant-rated tool.Design:This was a population-based cohort study.Setting:Participants were recruited from the Platform for Research Online to Investigate Genetics and Cognition in Aging study (https://www.protect-exeter.org.uk).Participants:A total of 5,742 participant-informant dyads participated in the study.Measurements:Both participants and informants completed the MBI-C. The factor structure of the MBI-C was evaluated by exploratory factor analysis.Results:The most common MBI-C items, as rated by self-reported and informants, related to affective dysregulation (mood/anxiety symptoms), being present in 34% and 38% of the sample, respectively. The least common items were those relating to abnormal thoughts and perception (psychotic symptoms) (present in 3% and 6% of the sample, respectively). Only weak correlations were observed between self-reported and informant-reported MBI-C responses. Exploratory factor analysis for both sets of respondent answers indicated that a five-factor solution for the MBI-C was appropriate, reflecting the hypothesized structure of the MBI-C.Conclusion:This is the largest and most detailed report on the frequency of MBI symptoms in a nondementia sample. The full spectrum of MBI symptoms was present in our sample, whether rated by self-reported or informant report. However, we show that the MBI-C performs differently in self-reported versus informant-reported situations, which may have important implications for the use of the questionnaire in clinic and research.

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Mild Behavioral Impairment as a Marker of Cognitive Decline in Cognitively Normal Older Adults

Abstract: The CogTrack TM System is proprietary to Wesnes Cognition Ltd (www.wesnes.com). Keith Wesnes owns Wesnes Cognition Ltd and consults for various companies involved in clinical trials. Helen Brooker is employed by Wesnes Cognition Ltd. Clive

Cited by 166 publications

References 38 publications

Mild behavioral impairment is related to frailty in cognitively normal older adults: a cross-sectional study

Mild behavioral impairment is related to frailty in cognitively normal older adults: a cross-sectional study

Prevalence of Mild Behavioral Impairment and Risk of Dementia in a Psychiatric Outpatient Clinic

Profile of mild behavioral impairment and factor structure of the Mild Behavioral Impairment Checklist in cognitively normal older adults

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