Neuropsychiatric symptoms as early manifestations of emergent dementia: Provisional diagnostic criteria for mild behavioral impairment

Abstract

Neuropsychiatric symptoms (NPS) are common in dementia and in predementia syndromes such as mild cognitive impairment (MCI). NPS in MCI confer a greater risk for conversion to dementia in comparison to MCI patients without NPS. NPS in older adults with normal cognition also confers a greater risk of cognitive decline in comparison to older adults without NPS. Mild behavioral impairment (MBI) has been proposed as a diagnostic construct aimed to identify patients with an increased risk of developing dementia, but who may or may not have cognitive symptoms. We propose criteria that include MCI in the MBI framework, in contrast to prior definitions of MBI. Although MBI and MCI can co-occur, we suggest that they are different and that both portend a higher risk of dementia. These MBI criteria extend the previous literature in this area and will serve as a template for validation of the MBI construct from epidemiologic, neurobiological, treatment, and prevention perspectives.

Cortical Thickness and Depressive Symptoms in Cognitively Normal Individuals: The Mayo Clinic Study of Aging

“…Our study results may be relevant to the recently reported construct of Mild Behavioral Impairment (MBI) [36]. Cognitively normal elderly persons with depressive symptoms can be classified to have MBI.…”

Neuropsychiatric Symptoms and Cognitive Impairment: Understanding the Importance of Co-Morbid Symptoms

“…The concept of MBI has been proposed as a latelife transitional state between normal cognitive aging and dementia (i.e., prodromal stage of dementia), in which the presence of later-life onset NPS in cognitively normal individuals or those with MCI confers an increased risk of developing dementia [22]. The current findings highlight the importance of NPS and the need for clinicians to consider the presence of NPS in cognitively normal as a possible risk state.…”

“…For example, Geda and colleagues [21] have shown that in cognitively healthy older adults (aged >70 years), the presence of NPS, specifically agitation, apathy, anxiety, irritability, depression, are linked to an increased risk of developing MCI in comparison with cognitively healthy without NPS. The concept of 'mild behavioral impairment' (MBI) has been proposed to describe this late-life transitional state, where the presence of NPS in the absence of cognitive symptoms confers an increased risk of incident MCI and dementia [22].…”

Eu/Us/Ctad Task Force: Lessons Learned From Recent and Current Alzheimer’s Prevention Trials

“…Early neuropsychiatric and behavioral symptoms and disorders may also be useful indicators of preclinical AD, a concept that has been termed “Mild Behavioral Impairment” (MBI), akin to MCI and with recent publication of provisional criteria and a checklist (39, 40). Multiple studies have demonstrated an association between neuropsychiatric symptoms and an increased risk of dementia and AD (41–44), although the mechanisms underlying this association remain unclear.…”