Highlights
- •What is the primary question addressed by this study?The purpose of this study was to examine neuropsychiatric symptom complexes in a population with mild cognitive impairment and assess whether these complexes were associated with more rapid progression to dementia or death without dementia.
- •What is the main finding of this study?In addition to a subgroup with mild or no neuropsychiatric symptoms, three subgroups were identified based on mood, hyperactive, or psychotic symptoms, and these three subgroups were at higher risk of dementia.
- •What is the meaning of the finding?Our results suggest that the structure of neuropsychiatric symptoms warrants further consideration in classification models of mild cognitive impairment to better predict the risk of disease progression.
ABSTRACT
Objective
To explore the heterogeneity of neuropsychiatric symptom (NPS) complexes in individuals
with mild cognitive impairment (MCI) and assess the relative risks of converting to
dementia or dying.
Design
Latent class analysis using 7,971 participants with MCI.
Setting
Participants in the Uniform Data Set (UDS) from 39 NIH Alzheimer's Disease Centers.
Participants
Persons with a diagnosis of MCI at initial visit from each center and with either
a Mini-Mental State Examination (MMSE) score of 22 or greater or an equivalent education-adjusted
Montreal Cognitive Assessment (MoCA) score of 16 or greater.
Measurements
Neuropsychiatric Inventory Questionnaire (NPI-Q) administered at initial visit.
Results
In addition to a subgroup with mild or no NPS (relative frequency, 50%), three empirically-based
subgroups of NPS were identified: 1) an “affect” or “negative mood” subgroup (27%)
with depression, anxiety, apathy, nighttime disturbance, and change in appetite; 2)
a “hyperactive” subgroup (14%) with agitation, irritability, and disinhibition; and
3) a “psychotic with additional severe NPS” subgroup (9%) with the highest risk of
delusions and hallucinations, as well as highest risk of all other NPS. Each of these
three subgroups had significantly higher risk of converting to dementia than the “mild
NPS” class, with the “psychotic with additional severe NPS” subgroup possessing a
64% greater risk. The subgroups did not differ in their risks of death without dementia.
Conclusion
Our findings of three NPS subgroups in MCI characterized by affect, hyperactive, or
psychotic features are largely consistent with a previous 3-factor model of NPS found
in a demented population. The consistency of these findings across studies and samples,
coupled with our results on the associated risks of converting to dementia, suggests
that the NPS structure is robust, and warrants further consideration in classification
models of MCI.
Key Words
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Article info
Publication history
Published online: January 02, 2022
Accepted:
December 29,
2021
Received in revised form:
December 28,
2021
Received:
August 24,
2021
Identification
Copyright
© 2022 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.
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- To Cluster or Not Cluster, That is the QuestionThe American Journal of Geriatric PsychiatryVol. 30Issue 8
- PreviewIt is becoming increasingly clear that Alzheimer's disease (AD) symptoms are not purely cognitive and that neuropsychiatric symptoms (NPS) are a frequent prodrome of AD. This has implications for prognosis and treatment, since NPS are frequently the first symptom of future cognitive and/or functional decline 1 and late-life NPS may be targets for AD prevention. Recent studies have largely (but not universally) reported NPS to be associated with risk of progression to mild cognitive impairment (MCI) or AD, and NPS including depression, anxiety, sleep disturbances and apathy have been implicated.
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