The Mild Behavioral Impairment Checklist (MBI-C): A Rating Scale for Neuropsychiatric Symptoms in Pre-Dementia Populations

Abstract

Background Mild Behavioral Impairment (MBI) is a construct that describes the emergence at ≥ 50 years of age of sustained and impactful neuropsychiatric symptoms (NPS), as a precursor to cognitive decline and dementia. MBI describes NPS of any severity, which are not captured by traditional psychiatric nosology, persist for at least 6 months, and occur in advance of or in concert with Mild Cognitive Impairment (MCI). While the detection and description of MBI has been operationalized in the International Society to Advance Alzheimer’s Research and Treatment – Alzheimer’s Association (ISTAART-AA) research diagnostic criteria, there is no instrument that accurately reflects MBI as described. Objective To develop an instrument based on ISTAART-AA MBI criteria. Methods Eighteen subject matter experts participated in development using a modified Delphi process. An iterative process ensured items reflected the 5 MBI domains of 1) decreased motivation; 2) emotional dysregulation; 3) impulse dyscontrol; 4) social inappropriateness; and 5) abnormal perception or thought content. Instrument language was developed a priori to pertain to non-demented functionally independent older adults. Results We present the Mild Behavioral Impairment Checklist (MBI-C), a 34-item instrument, which can easily be completed by a patient, close informant, or clinician. Conclusion The MBI-C provides the first measure specifically developed to assess the MBI construct as explicitly described in the criteria. Its utility lies in MBI case detection, and monitoring the emergence of MBI symptoms and domains over time. Studies are required to determine the prognostic value of MBI for dementia development, and for predicting different dementia subtypes.

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

“…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. Longitudinal follow-up of this PATH sample will be important to track the evolution of MBI in relation to cognitive decline and diagnosis [27]. Future research will also need to investigate how current symptom clusters compare to the symptoms contained in the five MBI domains, to determine their prognostic value for cognitive decline and dementia incidence.…”

“…Likewise, there has been sparse epidemiological research on the pattern of NPS across diagnostic groups and specifically, normal ageing (i.e., cognitively normal). Understanding such patterns will help inform our understanding of risk states such as MBI, and will assist with clinical assessment [27,28].…”

Examining differences in neuropsychiatric symptom factor trajectories in empirically derived mild cognitive impairment subtypes

“…Therefore, the utilization of the NPI‐Q with a population that may not have symptoms severe enough to warrant a diagnosis of dementia may be inappropriate. Future studies should examine relationships between ED‐MCI subtypes and NPS severity and progression using measures that may be more appropriate for the population such as the Mild Behavior Checklist (MBI‐C) . Lastly, because of its cross‐loading on both symptom factors, apathy was analyzed separately, rather than being included in the symptoms factors.…”

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.…”