Mei-Feng Huang1, Wei-Ju Lee2, Yi-Chun Yeh3, Yung-Shuan Lin4, Hsiu-Fen Lin5, Shuu-Jiun Wang6, Yi-Hsin Yang7, Cheng-Sheng Chen8, Jong-Ling Fuh9. 1. Department of Psychiatry, Kaohsiung Medical University Hospital, Taiwan; Department of Psychiatry, School of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: lalalabon@gmail.com. 2. Neurological Institute, Dementia and Parkinson's Disease Integrated Center, Taichung Veterans General Hospital, Taichung, Taiwan; Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan; Faculty of Medicine, Institute of Clinical Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan. Electronic address: weijlee@vghtc.gov.tw. 3. Department of Psychiatry, Kaohsiung Medical University Hospital, Taiwan; Department of Psychiatry, School of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: y7552156@gmail.com. 4. Faculty of Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan; Division of General Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan. Electronic address: anya.yslin@gmail.com. 5. Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan; Department of Neurology, College of Medicine, Kaohsiung Medical University, Taiwan. Electronic address: sflin@kmu.edu.tw. 6. Faculty of Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan; Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan. Electronic address: sjwang@vghtpe.gov.tw. 7. National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan. Electronic address: yhyang@nhri.edu.tw. 8. Department of Psychiatry, Kaohsiung Medical University Hospital, Taiwan; Department of Psychiatry, School of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: sheng@kmu.edu.tw. 9. Faculty of Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan; Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan. Electronic address: jlfuh@vghtpe.gov.tw.
Abstract
BACKGROUND: Neuropsychiatric symptoms (NPS) could increase mortality risk in people with dementia due to Alzheimer's disease (AD). However, whether NPS affects mortality risk in people with mild cognitive impairment (MCI) and whether any specific syndrome of NPS influences this risk are still unclear. METHODS: In total, 984 participants with dementia due to AD, 338 with MCI, and 365 controls were enrolled. Over a mean of 5-year follow-up, cause of death data were obtained from the Ministry of Health and Welfare in Taiwan. NPS were assessed using Neuropsychiatric Inventory Questionnaire (NPI-Q), and psychosis, mood, and frontal domain scores were determined. Survival analyses were conducted to determine the hazard ratio (HR) of death. RESULTS: In controlled analyses, HR of death for AD was 2.19 (95% confidence interval [CI] = 1.29-3.71) compared with the control group, whereas no statistical significance was noted for the MCI group. A high NPI-Q score (above the median score) increased mortality risk for both the MCI and AD groups, with HRs of 2.32 (95% CI = 1.07-5.03) and 2.60 (95% CI = 1.51-4.47), respectively. Among NPI-Q domain scores, only high mood domain, but not psychosis or frontal domain, scores increased death risk for both the MCI (HR = 2.89, 95% CI = 1.00-8.51) and AD (HR = 2.59, 95% CI = 1.47-4.55) groups. CONCLUSION: Mortality risk is high for patients with AD. Not only for AD, patients with MCI presenting with NPS, particularly mood symptoms, have high death risk.
BACKGROUND: Neuropsychiatric symptoms (NPS) could increase mortality risk in people with dementia due to Alzheimer's disease (AD). However, whether NPS affects mortality risk in people with mild cognitive impairment (MCI) and whether any specific syndrome of NPS influences this risk are still unclear. METHODS: In total, 984 participants with dementia due to AD, 338 with MCI, and 365 controls were enrolled. Over a mean of 5-year follow-up, cause of death data were obtained from the Ministry of Health and Welfare in Taiwan. NPS were assessed using Neuropsychiatric Inventory Questionnaire (NPI-Q), and psychosis, mood, and frontal domain scores were determined. Survival analyses were conducted to determine the hazard ratio (HR) of death. RESULTS: In controlled analyses, HR of death for AD was 2.19 (95% confidence interval [CI] = 1.29-3.71) compared with the control group, whereas no statistical significance was noted for the MCI group. A high NPI-Q score (above the median score) increased mortality risk for both the MCI and AD groups, with HRs of 2.32 (95% CI = 1.07-5.03) and 2.60 (95% CI = 1.51-4.47), respectively. Among NPI-Q domain scores, only high mood domain, but not psychosis or frontal domain, scores increased death risk for both the MCI (HR = 2.89, 95% CI = 1.00-8.51) and AD (HR = 2.59, 95% CI = 1.47-4.55) groups. CONCLUSION: Mortality risk is high for patients with AD. Not only for AD, patients with MCI presenting with NPS, particularly mood symptoms, have high death risk.