Trajectories of neuropsychiatric symptoms over time in healthy volunteers and risk of MCI and dementia

Abstract

Objectives To identify subtypes of neuropsychiatric symptom (NPS) course among cognitively normal individuals and to assess the association between these subtypes and hazard of later mild cognitive impairment (MCI) or dementia diagnosis. Methods We modeled neuropsychiatric inventory questionnaire (NPI‐Q) scores from 4184 volunteers over approximately 4 years using growth mixture models, generating latent classes of trajectory. We then fit Cox proportional hazard models to determine if membership in trajectory classes was associated with increased hazard of diagnosis of MCI or dementia. Results We identified four trajectory classes: the majority of the sample (65%) would be expected to belong to a class with consistently low or zero NPS. The next most prevalent class, (16%) showed a decrease over time in NPI‐Q total score but, compared with the majority class had an almost threefold increase in hazard of MCI or dementia (HR: 2.92; 95% CI: 1.82‐4.68). Another class (14%) showed an increase in NPS over time and was also associated with greater hazard of MCI or dementia (HR: 3.96; CI: 2.61‐6.03). The smallest class (5%) had high and fluctuating NPI‐Q total scores and had the greatest hazard (HR: 4.57; CI: 2.72‐7.63). Conclusion We have demonstrated that it is possible to identify meaningful groups of NPS trajectories and that trajectory of NPS can convey information beyond a single cross‐sectional measure. While even those whose NPS improved were at increased hazard of MCI or dementia, hazard increased as a function of the severity of the NPS trajectory.

Cluster Analysis of the Associations among Physical Frailty, Cognitive Impairment and Mental Disorders

“…Follow up of individuals in these clusters could also determine whether reduced cognitive function, as in some individuals in cluster 4, is due to cognitive impairment or to interference by high anxiety level, which was found to significantly influence membership in this cluster [ 60 ]. Indeed, recent studies have found that the presence of symptoms of mental disorders in older, cognitively unaffected people increases their risks for cognitive impairment [ 21 ].…”

“…Physical conditions in later life, especially in individuals with multimorbidity, have been closely associated with mental conditions, especially anxiety and depression, with these physical and mental conditions acting sinergistically to increase the probability of negative health-related outcomes [ 2 , 17 , 18 ]. Anxiety and depression in older people manifest as a variety of symptoms, including anxious feelings, dysphoria, apathy, worry, trouble sleeping, irritability, and fatigue [ 19 – 21 ]. These symptoms of anxiety and depression may overlap with each other, as well as with cognitive and physical conditions, making mental conditions more difficult to recognize in older persons, especially in primary care (PC) situations, in which patients present with different symptoms and morbidities.…”

Association between Motor Signs and Cognitive Performance in Cognitively Unimpaired Older Adults: A Cross-Sectional Study Using the NACC Database

“…The following exclusions were applied: (1) treatment with an FDA-approved medication for AD; (2) presence of a psychiatric disorder diagnosed on clinical basis; (3) treatment with hypnotic, antipsychotic, sedative or anxiolytic drugs. The rational for these exclusions was to avoid potential confounding effects of these conditions on cognitive performance [ 30 , 31 , 32 ].…”

Neuropsychiatric symptoms and cerebrovascular risk in non‐demented elders: cross‐sectional study using the mild behavioural impairment checklist (MBI‐C)

“…It is reasonable to mention that a group of individuals with neuropsychiatric symptoms does not progress to dementia, keeping up a relatively stable cognitive trajectory. In a 4‐year follow‐up of individuals with NC, Leoutsakos et al 65 . found that 16% of them, with neuropsychiatric symptoms treated with antidepressants and additional procedures, achieved a favourable trajectory over this period.…”