Moyra E Mortby1,2, Richard Burns1, Ranmalee Eramudugolla1, Zahinoor Ismail3, Kaarin J Anstey1. 1. Centre for Research on Ageing, Health andWellbeing, Research School of Population Health, The Australian National University, Canberra, Australia. 2. NHMRC National Institute for Dementia Research, Australia. 3. Departments of Psychiatry and Clinical Neurosciences, Mathison Centre for Mental Health Research &Education, Ron and Rene Centre for Healthy Brain Aging Research, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.
Abstract
BACKGROUND: Neuropsychiatric symptoms (NPS) are common in older adults with cognitive impairment, yet little is known about population-based prevalence and clinical implications of co-morbid symptom presentation across the spectrum from normal cognition to dementia. OBJECTIVE: To characterize the prevalence of NPS and explore the clinical implications of co-morbid symptom presentation. METHODS: Cross-sectional study of 1,417 older adults (aged 73-79) with dementia (n = 40); with mild cognitive impairment (MCI; n = 133); who are 'cognitively normal, but-at-risk' (CN-AR; n = 397); and who are cognitively normal (n = 847). NPS were assessed by the Neuropsychiatric Inventory. Cluster analyses were conducted using a latent class analysis (LCA). RESULTS: NPS are highly prevalent across the cognitive function spectrum (30.8% -80%). NPS were associated with a 3-fold increased risk of dementia, a 2-fold increased risk of MCI, and a 1.5-times increased risk of CN-AR. Each additional co-morbid symptom was associated with an additional 1.5-times increased risk of dementia, but not MCI or CN-AR. LCA revealed four distinctive sub-populations: 1) frontal/low comorbidity; 2) high prevalence/high comorbidity; 3) affective/low comorbidity; and 4) sleep/low comorbidity. CONCLUSION: Our findings confirm previous reports on the prevalence of NPS in community-based samples and are consistent with the profiles of NPS domain characteristics of MCI and dementia. Number of co-morbid NPS and not symptom clusters are associated with increased risk of dementia. Understanding such patterns will help inform our understanding of mild behavioral disorders and assist with clinical assessment.
BACKGROUND:Neuropsychiatric symptoms (NPS) are common in older adults with cognitive impairment, yet little is known about population-based prevalence and clinical implications of co-morbid symptom presentation across the spectrum from normal cognition to dementia. OBJECTIVE: To characterize the prevalence of NPS and explore the clinical implications of co-morbid symptom presentation. METHODS: Cross-sectional study of 1,417 older adults (aged 73-79) with dementia (n = 40); with mild cognitive impairment (MCI; n = 133); who are 'cognitively normal, but-at-risk' (CN-AR; n = 397); and who are cognitively normal (n = 847). NPS were assessed by the Neuropsychiatric Inventory. Cluster analyses were conducted using a latent class analysis (LCA). RESULTS:NPS are highly prevalent across the cognitive function spectrum (30.8% -80%). NPS were associated with a 3-fold increased risk of dementia, a 2-fold increased risk of MCI, and a 1.5-times increased risk of CN-AR. Each additional co-morbid symptom was associated with an additional 1.5-times increased risk of dementia, but not MCI or CN-AR. LCA revealed four distinctive sub-populations: 1) frontal/low comorbidity; 2) high prevalence/high comorbidity; 3) affective/low comorbidity; and 4) sleep/low comorbidity. CONCLUSION: Our findings confirm previous reports on the prevalence of NPS in community-based samples and are consistent with the profiles of NPS domain characteristics of MCI and dementia. Number of co-morbid NPS and not symptom clusters are associated with increased risk of dementia. Understanding such patterns will help inform our understanding of mild behavioral disorders and assist with clinical assessment.
Authors: David S Knopman; Samantha Budd Haeberlein; Maria C Carrillo; James A Hendrix; Geoff Kerchner; Richard Margolin; Paul Maruff; David S Miller; Gary Tong; Maria B Tome; Melissa E Murray; Peter T Nelson; Mary Sano; Niklas Mattsson; David L Sultzer; Thomas J Montine; Clifford R Jack; Hartmuth Kolb; Ronald C Petersen; Prashanthi Vemuri; Megan Zoschg Canniere; Julie A Schneider; Susan M Resnick; Gary Romano; Argonde Corien van Harten; David A Wolk; Lisa J Bain; Eric Siemers Journal: Alzheimers Dement Date: 2018-04 Impact factor: 21.566