Neuropsychiatric Symptoms as Risk Factors for Progression From CIND to Dementia: The Cache County Study

Abstract

Objectives To examine the association of neuropsychiatric symptom (NPS) severity with risk of transition to all-cause dementia, Alzheimer's disease (AD), and vascular dementia (VaD). Design Survival analysis of time to dementia, AD, or VaD onset. Setting Population-based study. Participants 230 participants diagnosed with cognitive impairment, no dementia (CIND) from the Cache County Study of Memory Health and Aging were followed for a mean of 3.3 years. Measurements The Neuropsychiatric Inventory (NPI) was used to quantify the presence, frequency, and severity of NPS. Chi-square statistics, t-tests, and Cox proportional hazard ratios were used to assess associations. Results The conversion rate from CIND to all-cause dementia was 12% per year, with risk factors including an APOE ε4 allele, lower MMSE, lower 3MS, and higher CDR sum-of-boxes. The presence of at least one NPS was a risk factor for all-cause dementia, as was the presence of NPS with mild severity. Nighttime behaviors were a risk factor for all-cause dementia and of AD, while hallucinations were a risk factor for VaD. Conclusions These data confirm that NPS are risk factors for conversion from CIND to dementia. Of special interest is that even NPS of mild severity are a risk for all-cause dementia or AD.

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

“…It is well accepted that the comorbid presentation of NPS in MCI is linked to higher progression to dementia [9][10][11][12][13][14][15] and that for patients with Alzheimer's disease (AD), NPS are associated with an increased likelihood of progression from mild to severe dementia [16].…”

Spectrum of cognition short of dementia

“…MCI occupies a central location in the spectrum of cognitive aging, and its use as a diagnostic term has been criticized because of the heterogeneity of its prognosis. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] There are many reasons for the wide range of dementia risk in persons designated as MCI, but perhaps the most important one is that cognitive functioning that falls between the designations of "typical cognitive aging" and "definitely demented" is remarkably diverse. Changes in memory, attention, executive, language, and visuospatial domains, as well as the magnitude of those changes, have distinct implications for prognosis.…”

Analysis of Related Factors of Behavioral and Psychiatric Symptoms in Vascular Dementia

“…But with the extensive use of NPI in the psychiatry symptoms research of dementia, based on the study of AD patients, the researchers groups found that NPI could be divided into 3 syndrome [19][20][21], namely, affective disorder (including depression and anxiety), psychotic (delusions and hallucinations) and loss of control behavior (including irritable, emotional instability, indifference and abnormal behavior). NPI could also be divided into 4 syndrome, namely, affective disorder, psychotic, abnormal behavior and loss of self-control [8,22,23]. At present, the related research based on VaD patients is rare.…”