Abstract
Examine the association between neuropsychiatric symptoms (NPS) and clinical outcome in memory clinic patients with vascular brain injury. TRACE-VCI prospective memory clinic cohort with follow-up (2.1 ± 0.5 years). Five hundred and seventy-five memory clinic patients with vascular brain injury on MRI (i.e. possible Vascular Cognitive Impairment [VCI]). Severity of cognitive impairment ranged from no objective cognitive impairment to mild cognitive impairment (MCI) and dementia. We used Neuropsychiatric Inventory (total score and score on hyperactive, psychotic, affective, and apathetic behavior domains) to measure NPS. We assessed the association between NPS and institutionalization, mortality and cognitive deterioration (increase ≥0.5 on Clinical Dementia Rating scale) with Cox proportional hazards models and logistic regression analyses. NPS were present in 89% of all patients, most commonly in the hyperactive and apathetic behavior domain. Across the whole cohort, affective behavior was associated with institutionalization (HR: 1.98 [1.01-3.87]), mainly driven by the dementia subgroup (HR: 2.06 [1.00-4.21]). Apathetic behavior was associated with mortality and cognitive deterioration (HR: 2.07 [1.10-3.90],OR: 1.67 [1.12-2.49], respectively), mainly driven by the MCI subgroup (HR: 4.93 [1.07-22.86],OR: 3.25 [1.46-7.24], respectively). Conversely, hyperactive behavior was related to lower mortality (HR: 0.54 [0.29-0.98]), again particularly driven by the MCI subgroup (HR:0.17 [0.04-0.75]). Psychotic behavior was associated with cognitive deterioration in patients with no objective cognitive impairment (OR: 3.10 [1.09-8.80]) and with institutionalization in MCI (HR: 12.45 [1.28-121.14]). NPS are common and have prognostic value in memory clinic patients with possible VCI. This prognostic value depends on the severity of cognitive impairment.
Highlights
Almost half (47%) of the patients was diagnosed with dementia, 32% with mild cognitive impairment (MCI) and 21% had no objective cognitive impairment (NOCI)
Patients with moderate and high scores on Neuropsychiatric Inventory (NPI) had more often dementia compared to patients with low scores on the NPI (47% [x2 = 4.06, p = 0.044] and 55% [x2 = 12.14, p
We found no relation between NPI severity, vascular risk factors and type of vascular brain injury
Summary
Neuropsychiatric symptoms (NPS) are important and disruptive clinical features in patients with cognitive impairment and dementia. NPS are common across the clinical spectrum from mild cognitive impairment (MCI) to dementia, with 35%−85% of patients with MCI and most patients with dementia showing NPS.− NPS are associated with increased caregiver burden, higher costs of care, worse cognitive performance and poorer quality of life.− NPS predict a worse prognosis including more rapid progression of cognitive and functional decline, earlier institutionalization and death. The latter has been primarily investigated for all-cause dementia and Alzheimer’s disease (AD).Vascular brain injury is known to be the second most common cause of cognitive impairment and dementia after AD. Vascular cognitive impairment (VCI) is a construct that covers the entire spectrum of cognitive disorders, ranging from mild cognitive impairment to dementia, due to all forms of vascular brain injury. Vascular brain injury is known to be a significant factor causing NPS by cortical and subcortical disturbances of frontal-subcortical circuits mediating behavior like motivation, mood and inhibition.− apathy, depression, irritability and agitation are the most prevalent reported NPS in VCI. Whether NPS have prognostic value in VCI is yet unknown. NPS are common across the clinical spectrum from mild cognitive impairment (MCI) to dementia, with 35%−85% of patients with MCI and most patients with dementia showing NPS.− NPS are associated with increased caregiver burden, higher costs of care, worse cognitive performance and poorer quality of life.− NPS predict a worse prognosis including more rapid progression of cognitive and functional decline, earlier institutionalization and death.. NPS are common across the clinical spectrum from mild cognitive impairment (MCI) to dementia, with 35%−85% of patients with MCI and most patients with dementia showing NPS.− NPS are associated with increased caregiver burden, higher costs of care, worse cognitive performance and poorer quality of life.− NPS predict a worse prognosis including more rapid progression of cognitive and functional decline, earlier institutionalization and death.5,8,9 The latter has been primarily investigated for all-cause dementia and Alzheimer’s disease (AD).
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