Neuropsychiatric symptom clusters help spot higher-risk MCI

  • Liew TM
  • J Am Med Dir Assoc
  • 26 Mar 2019

  • International Clinical Digest
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Takeaway

  • Older adults with mild cognitive impairment (MCI) were at elevated risk for dementia if they had affective symptoms or psychotic symptoms, but not if they had hyperactivity symptoms.

Why this matters

  • Previous research has focused on individual symptoms rather than symptom clusters.

Key results

  • 3 symptom clusters were identified:
    • Affective symptoms: depression, anxiety, apathy, sleep, appetite (54.1% of patients).
    • Hyperactivity symptoms: agitation, irritability, disinhibition (34.3% of patients).
    • Psychotic symptoms: delusions, hallucinations (4.8% of patients).
  • During median 4-year follow-up among 5957 patients, 41.6% developed dementia.
  • Dementia risk was significantly elevated among patients with:
    • Affective symptoms (HR, 1.6; P<.001>
    • Psychotic symptoms (HR, 1.6; P=.004).
  • No significant association seen for hyperactivity symptoms.
  • Patients with both affective symptoms and psychotic symptoms had more than doubling of risk (HR, 2.5; 95% CI, 2.0-3.2).
  • Half of patients in this group developed dementia within 2.7 years.

Study design

  • Prospective cohort study of 8530 patients aged ≥60 years (median, 76 years) with MCI seen at Alzheimer’s Disease Centers across the United States.
  • All completed Neuropsychiatric Inventory–Questionnaire at baseline.
  • Main outcome: dementia.
  • Funding: National Institute on Aging.

Limitations

  • Patients were volunteers, mostly white, well-educated.
  • Large majority of dementia cases were Alzheimer’s disease.

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