Neuropsychiatric and Cognitive Symptoms: Two Sides of the Same Coin?

Background Neurocognitive and neuropsychiatric symptoms are essential clinical manifestations of age-related cognitive impairment, yet their patterns of co-existence remain unclear through the cognitive continuum. Objective To examine the associations of person-centered cluster-derived patterns, based on a comprehensive collection of domain-specific cognitive and neuropsychiatric assessments, with neuroimaging markers and dementia risk. Methods 641 participants were included in the analysis from memory clinics in Singapore. Latent class analysis was applied to define clusters of individuals with different clinical patterns. The associations between identified clinical groups with neuroimaging markers of cerebrovascular diseases and neurodegeneration were analyzed using logistic regression models. Cox proportional hazard models were applied for incident dementia. Results Three latent classes differing in neurocognitive and neuropsychiatric impairment were identified (Class 1 “memory impairment only”; Class 2 “global cognitive impairment”; Class 3 “global cognitive and neuropsychiatric impairment”). Compared with Class 1, Class 2 and 3 were associated with smaller brain volumes, moderate-to-severe cortical atrophy and medial temporal lobe atrophy, and the presence of all cerebrovascular lesions. Moreover, compared with Class 2, Class 3 had smaller brain volumes, moderate-to-severe cortical atrophy and presence of intracranial stenosis. Additionally, compared to Class 1, Class 2 (hazard ratio [HR] = 3.84, 95%CI 2.11–7.00), and Class 3 (HR = 6.92, 95%CI 2.84–16.83) showed an increased risk of incident dementia. Conclusions Participants characterized by multi-domain cognitive impairment and co-occurrence of cognitive and neuropsychiatric impairment showed the highest risk of incident dementia, which may be attributed to both neurodegenerative and cerebrovascular pathologies.

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Longitudinal Trajectories of Cognitive Function, Functional Ability, and Neuropsychiatric Symptoms in Alzheimer's Disease: The Mediating Role of IADL and the Impact of COVID-19 Lockdown in South Korean Older Adults

Lee,

Shin,

Nam

et al. 2024

Preprint

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Background: The progression of Alzheimer's Disease (AD) and its interaction with COVID-19-induced social isolation remains poorly understood. This study investigated the longitudinal trajectories of AD severity on cognitive function, functional ability, and neuropsychiatric symptoms, and examined the impact of COVID-19 lockdown on AD patients in South Korea. Methods: In this retrospective longitudinal study, data from 253 adults (aged ≥ 55) diagnosed with mild cognitive impairment (MCI) or AD were analyzed, collected between 2018 and 2022. Participants were classified into four groups based on Clinical Dementia Rating (CDR) scores: MCI, AD-CDR0.5, AD-CDR1, and AD-CDR2. Cognitive function, functional abilities, neuropsychiatric symptoms, depressive symptoms, and overall dementia severity were assessed. Linear mixed-effects models, along with mediation and moderation analyses were employed to analyze the data. Results: Significant trajectories of decline in cognitive function and functional abilities were observed over time, with more pronounced declines in higher AD severity groups. The COVID-19 lockdown exacerbated cognitive decline and impairment in Activities of Daily Living (ADL) specifically in the most severe AD group (AD-CDR2). Instrumental Activities of Daily Living (IADL) mediated the relationship between Mini-Mental State Examination (MMSE) scores and CDR Sum of Boxes (CDR-SB) in the MCI, AD-CDR0.5, and AD-CDR1 groups. A significant interaction between MMSE scores and neuropsychiatric symptoms was observed in the moderate AD group (AD-CDR1), indicating that worsening neuropsychiatric symptoms intensified cognitive decline. Neuropsychiatric Inventory (NPI) scores increased over time, indicating worsening neuropsychiatric symptoms, whereas depressive symptoms, measured by the Short Geriatric Depression Scale (SGDS), remained stable over the study period. Conclusions: This study highlights the impact of AD severity on cognitive and functional decline, further exacerbated by the COVID-19 lockdown. The mediating role of IADL suggests that maintaining complex daily activities may be crucial in slowing disease progression in AD patients. Additionally, the worsening of neuropsychiatric symptoms underscores the need for targeted mental health support, especially during periods of social isolation, to mitigate adverse effects on patients and caregivers.

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Neuropsychiatric and Cognitive Symptoms: Two Sides of the Same Coin?

Cited by 4 publications

References 45 publications

The association between precuneus cortex thickness and mild behavioral impairment in patients with mild stroke

The association between precuneus cortex thickness and mild behavioral impairment in patients with mild stroke

Associations of neurocognitive and neuropsychiatric patterns with brain structural biomarkers and dementia risk: A latent class analysis

Longitudinal Trajectories of Cognitive Function, Functional Ability, and Neuropsychiatric Symptoms in Alzheimer's Disease: The Mediating Role of IADL and the Impact of COVID-19 Lockdown in South Korean Older Adults

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