Abstract
Background: Neuropsychiatric symptoms (NPS) and cognitive impairments are both common in patients with late-life depression (LLD). However, the relationship between NPS and cognitive functions in LLD patients remains unclear. The current study aims to explore the effects of NPS on cognitive impairments in LLD patients.Methods: Two hundred and sixty-two LLD patients and 141 normal controls (NC) were recruited. Exploratory factor analysis was used to extract factors from the Neuropsychiatric Inventory (NPI). Correlation, mediation, and moderation analyses were used to explore whether NPS exacerbated the cognitive impairments in LLD and whether NPS exhibited different effects on cognitive impairments in acute-state LLD (aLLD) and recovery-state LLD (rLLD).Results: Three main factors were extracted from the NPI, including emotional, behavioral, and psychotic factors. The patients with LLD exhibited worse cognition and higher NPI scores, and the scores of NPI-total and three extracted factors were negatively associated with cognitive scores. The mediation analyses exhibited that NPI-total and behavioral factor scores increase the difference in cognition scores between LLD and NC groups. The mediation analyses exhibited that behavioral factor score played a greater effect on impairing MMSE in the rLLD group than in the aLLD group. Additionally, behavioral factor score was in a trend to be negatively associated with Mini-Mental State Examination (MMSE) score changes at a one-year follow-up (p = 0.051).Conclusions: NPS, especially behavioral symptoms, exacerbate cognitive impairments in LLD and may contribute to residual cognitive impairment in rLLD patients. Early intervention for behavioral symptoms in LLD patients may be beneficial to their long-term clinical prognosis.
Highlights
Late-life depression (LLD), defined as major depression occurring in an older adult (60 years or older), is a global public health problem that severely limits psychosocial function and increases mortality [1, 2]
Significant differences were found in years of education, HAMD scores, Neuropsychiatric Inventory (NPI)-total scores, MMSE scores, and scores in all domains of cognitive function between the normal controls (NCs) group and LLD group (p < 0.001)
Because of the existence of a mediating effect of Neuropsychiatric symptoms (NPS) on cognition in the LLD patients, the present study subsequently explored the differential effects of NPS on cognition between acute-state LLD (aLLD) and recovery-state LLD (rLLD) patients
Summary
Late-life depression (LLD), defined as major depression occurring in an older adult (60 years or older), is a global public health problem that severely limits psychosocial function and increases mortality [1, 2]. Sustained cognitive deficits in individuals suffering from LLD have been associated with higher depression relapse rates, poorer responses to antidepressant treatment, accelerated rates of functional decline, and progression to dementia [5,6,7,8,9]. A previous study suggested that cognitive impairments persisted in 94% of LLD patients with cognitive deficits at baseline, despite have reached depression remission [10], suggesting that there may be other factors influencing cognition other than depression. It is important to explore which other factors may influence cognitive function in patients with LLD because they may inform early intervention and lead to better prognosis. Neuropsychiatric symptoms (NPS) and cognitive impairments are both common in patients with late-life depression (LLD). The current study aims to explore the effects of NPS on cognitive impairments in LLD patients
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