A - 48 Neuropsychiatric Symptom Severity Predicts Rate of Executive Function Decline.

Abstract

Neuropsychiatric symptoms (NPS) are considered diagnostic and prognostic indicators of dementia and are attributable to neurodegenerative processes. NPS are distressing for patients and caregivers and are associated with accelerated functional decline, hospitalization, and institutionalization. Evaluation of NPS effects on disease course may reduce patient and caregiver distress and support development of personalized treatments. We examined whether baseline NPS predicted the rate of executive function (EF) decline among older adults with cognitive impairment. Older adults (n = 1155) with cognitive impairment and four years of data were selected from the National Alzheimer's Coordinating Center database v3-v3.2. Overall EF was estimated with a latent factor indicated by scores on Number Span Backward, Letter Fluency, and Trail Making-Part B. Strict temporal invariance was established. A curve of factors (CUFF) latent growth curve model was estimated to examine rate of change. Baseline NPS severity was entered as a predictor to examine its influence on the rate of change in EF over time. The predicted CUFF model exhibited good fit (χ2[69] = 201.46, p < 0.001; CFI = 0.98, RMSEA = 0.04). EF significantly declined over four waves (slope = -0.53). NPS severity at baseline predicted decline in EF (β= 0.164, p = 0.001), such that those with greater NPS severity demonstrated a more rapid decrease in EF performance over time. Increased NPS severity at baseline predicts more rapid decline in EF over four years. Findings highlight the prognostic value of NPS on cognitive decline and underscore the importance of targeting NPS at early disease stages. Future research will examine influence of individual NPS on rate of cognitive decline.