AFFECTIVE DISTURBANCE IN MILD COGNITIVE IMPAIRMENT

Abstract

Introduction Mild cognitive impairment (MCI) is an identifiable, prodromal stage of cognitive impairment. To better identify the differences in patients with MCI, the diagnosis has been further defined into subtypes: amnestic, language, executive functioning, and multi-domain/mixed MCI (Jak et al. 2009). Determining these subtypes can be helpful in predicting the trajectory and prognosis of a patient's disease. Affective disturbance can be present in a number of different types of dementia and MCI and carries significant stress to both the patient and caregivers. The most common mood changes occur as depression, anxiety, apathy, and irritability (Hwang et al., 2004, Rozzini et al., 2008, Lulio et al., 2010). The appearance of these symptoms has been found in up to 50% of patients with dementia prior to the onset of neurocognitive symptoms and has been related to a more rapid neurocognitive decline (Trivedi et al., 2013, Gallagher et al. 2017). Consequently, there has been an increased interest in identifying both neurocognitive and neuropsychiatric symptoms as early as possible for quicker intervention. Previous papers have looked at affective disturbance in an individual subtype of MCI but not the differences between subtypes. The purpose of this study is to (1) examine the differences in depression, anxiety, and apathy between MCI subtypes; and (2) assess the relationship between the neurocognitive domains (executive functioning, language, and episodic memory) and affective symptoms. We hypothesize that apathy will be greater in dysexecutive/mixed MCI (dys/mixed MCI) and related to greater neurocognitive deficits compared to depression or anxiety. Methods This is a retrospective study of 111 patients from the New Jersey Institute for Successful Aging Memory Assessment Program (MAP) who were administered a comprehensive neuropsychological protocol assessing executive functioning, language, and episodic memory. All tests were administered by an experienced neuropsychologist. Patients meeting criteria for dementia were excluded. Affective symptoms of depression, anxiety, and apathy were assessed by caregiver report using the Neuropsychiatric Inventory (NPI). Differences in age, gender, and instrumental activities of daily living were also recorded. Using Jak, Bondi (2009) criteria neuropsychological test performance categorized patients as presenting with non-MCI (patients that do not meet MCI criteria), amnestic MCI (aMCI), or a combined dys/mixed MCI. Patients were assigned to the aMCI group if memory test scores were more than one standard deviation below the normative values in 2 of 3 episodic memory parameters. Patients were assigned to the dys/mixed MCI group if the test scores were more than one standard deviation below the normed mean in 2 of 3 tests across multiple neurocognitive domains. Patients with dysexecutive and mixed MCI were combined due to the small number of patients meeting criteria for dysexecutive MCI. Prior research has shown that dysexecutive MCI and mixed MCI patients present with similar patterns of impairment on executive tests (Bondi et al., 2014, Thomas et al., 2017, & Eppig et al., 2012). Results The three MCI groups will be compared on symptoms of depression, anxiety, and apathy as measured by the NPI, using analysis of co-variance. A second analysis will look at the three tests that comprise each of the three cognitive domains as they are related to anxiety, depression, and apathy using a step-wise multiple regression. Conclusions We hypothesize that apathy will be greater in dysexecutive/mixed MCI (dys/mixed MCI) and related to greater neurocognitive deficits compared to depression or anxiety. The results and conclusion will be completed soon for the poster as well as submission for publication. This research was funded by All resources were supplied by the Departments of Geriatrics, Gerontology, and Psychology, New Jersey Institute for Successful Aging, Rowan University-School of Osteopathic Medicine, Stratford, NJ, USA.