Neuropsychiatric symptoms in mild cognitive impairment: a population‐based study

Introduction: Few studies have examined neuropsychiatric symptoms in community dwelling older adults with mild cognitive impairment (MCI). In the present study, we compared the prevalence of neuropsychiatric symptoms in older adults with normal cognition, MCI, and dementia in a population‐based sample. Methods: Subjects were selected from the Singapore Longitudinal Ageing study. Normal cognitive function was defined as Clinical Dementia Rating (CDR) global score=0 and Mini‐Mental State Examination (MMSE) total score ≥24. MCI was defined as CDR global score=0.5, and dementia was defined as CDR global score ≥1. Neuropsychiatric Inventory (NPI) was administered on reliable informants for 293 subjects (136 normal, 133 MCI, and 24 dementia). Results: The prevalence of neuropsychiatric symptoms (at lest one symptom) was 5.9% for normal cognition, 12.8% for MCI, and 50% for dementia. The most common neuropsychiatric symptoms in subjects with MCI were depression/dysphoria (6.8%), irritability/lability (3.8%), apathy/indifference (2.3%), and agitation/aggression (2.3%). NPI total score increased with increasing CDR global score (P<0.001). The adjusted mean NPI total score was 0.07 (SEM=0.49) for normal cognition, 0.86 (SEM=0.46) for MCI, and 4.50 (SEM=0.82) for dementia. Discussion: In community dwelling Asian older adults, we found an increasing prevalence of neuropsychiatric symptoms in subjects with normal cognition, MCI and dementia. Further studies with larger samples and strict criteria for MCI in an Asian population should be conducted.     

Psychiatric symptoms/syndromes in elderly persons with mild cognitive impairment. Data from a cross-sectional study

Objective – This study examined the prevalence of psychiatric syndromes and symptoms in elderly persons with mild cognitive impairment (MCI).
Methods – Data from a population-based study (the Kungsholmen Project) were used. All subjects with a Mini-Mental State Examination (MMSE) score ≤23 and a comparable random of those ≥24 were selected for further examination. Physicians carefully examined the included persons and those affected with dementia were excluded. The rest were stratified into 14 groups according to age and level of education. The mean MMSE score was calculated for each group and those subjects with scores 1SD below the age- and education-specific mean were classified as MCI. A structured psychiatric interview was performed and diagnoses of depression, anxiety and psychosis were made according to DSM-III-R.
Results – Being suspicious was the only symptom and being affected by an anxiety syndrome was the only diagnosis found to be associated with MCI. The association with suspiciousness might reflect the feeling of losing control that probably accompanies the loss of cognitive function experienced by the person. The association with anxiety syndromes might be a result of the fact that physical disorders have been reported to be more common in persons with cognitive impairment, as well as in persons with anxiety syndromes.
Conclusion – The results of this study suggest that the psychiatric syndromes present in MCI might be related to MCI per se . Additionally, it might reflect a developing dementia or a concomitant physical disorder.     

Prevalence and characteristics of depression in mild cognitive impairment: the Sydney Memory and Ageing Study

Shahnawaz Z, Reppermund S, Brodaty H, Crawford JD, Draper B, Trollor JN, Sachdev PS. Prevalence and characteristics of depression in mild cognitive impairment: the Sydney memory and ageing study. Objective: Depression might be a risk factor for dementia. However, little is known about the prevalence of depressive symptoms in mild cognitive impairment (MCI) and whether mood or motivation‐related symptoms are predominant. Method: A total of 767 non‐demented community‐dwelling adults aged 70–90 years completed a comprehensive assessment, including neuropsychological testing, and a past psychiatric/medical history interview. Depressive symptoms were assessed using the Geriatric Depression Scale (GDS) and Kessler Psychological Distress Scale (K10). Exploratory factor analysis was performed on the GDS and K10 to derive ‘mood’ and ‘motivation’ subscales. Results: A total of 290 participants were classified as having MCI and 468 as cognitively normal (CN). Participants with MCI reported more depressive symptoms, and more MCI participants met the cut‐off for clinically significant symptoms, relative to CN participants. Those with amnestic MCI (aMCI), but not non‐amnestic MCI, had more depressive symptoms and were more likely to meet the cut‐off for clinically significant depressive symptoms, relative to CN participants. Participants with MCI reported more mood‐related symptoms than CN participants, while there were no differences between groups on motivation‐related symptoms. Conclusion: Individuals with MCI, especially aMCI, endorse more depressive symptoms when compared with cognitively intact individuals. These findings highlight the importance of assessing and treating depressive symptoms in MCI.     

Amnestic mild cognitive impairment in Parkinson's disease: A brain perfusion SPECT study

The purpose of this study was to investigate cortical dysfunction in Parkinson's disease (PD) patients with amnestic deficit (PD‐MCI). Perfusion single photon emission computed tomography was performed in 15 PD‐MCI patients and compared (statistical parametric mapping [SPM2]) with three groups, i.e., healthy subjects (CTR), cognitively intact PD patients (PD), and common amnestic MCI patients (aMCI). Age, depression, and UPDRS‐III scores were considered as confounding variables. PD‐MCI group (P < 0.05, false discovery rate–corrected for multiple comparisons) showed relative hypoperfusion in bilateral posterior parietal lobe and in right occipital lobe in comparison to CTR. As compared to aMCI, MCI‐PD demonstrated hypoperfusion in bilateral posterior parietal and occipital areas, mainly right cuneus and angular gyrus, and left precuneus and middle occipital gyrus. With a less conservative threshold (uncorrected P < 0.01), MCI‐PD showed hypoperfusion in a left parietal region, mainly including precuneus and inferior parietal lobule, and in a right temporal‐parietal‐occipital region, including middle occipital and superior temporal gyri, and cuneus‐precuneus, as compared to PD. aMCI versus PD‐MCI showed hypoperfusion in bilateral medial temporal lobe, anterior cingulate, and left orbitofrontal cortex. PD‐MCI patients with amnestic deficit showed cortical dysfunction in bilateral posterior parietal and occipital lobes, a pattern that can be especially recognized versus both controls and common aMCI patients, and to a lesser extent versus cognitively intact PD. The relevance of this pattern in predicting dementia should be evaluated in longitudinal studies. © 2008 Movement Disorder Society     

Do symptoms of memory impairment correspond to cognitive impairment: a cross sectional study of a clinical cohort

BACKGROUND: Symptoms of memory loss are a common complaint within the general population and a frequent reason for seeking medical advice. However, the clinical relevance of these symptoms to future development of neurodegenerative disease is uncertain. The aim of this study is to characterise a cohort of individuals with symptoms of memory loss and varying memory impairment, who will be followed longitudinally with serial neuropsychology and neuroimaging to evaluate the clinical relevance of symptoms of memory loss. METHOD: Fifty-eight subjects with symptoms of memory loss were recruited from the National Hospital for Neurology and Neurosurgery. All subjects underwent clinical assessment, APOE4 genotyping, neuroimaging and neuropsychological tests. RESULTS: Those with mild cognitive impairment (MCI) had an increased prevalence of the APOE4 allele, impaired performance on tests of memory, measures of IQ and naming compared to controls. Baseline brain volumes were decreased and ventricular size increased. Those with symptoms of memory loss but no cognitive impairment (SNCI) performed significantly worse on tests of memory than the control group. CONCLUSIONS: The MCI represent a group with multiple risk factors for progression to AD. The SNCI group may represent a heterogeneous group with some individuals in the early stages of AD whilst others' memory complaints are more likely linked to anxiety or personality traits.     

Neuropsychiatric symptoms in the community-based patients with mild cognitive impairment and the influence of demographic factors

OBJECTIVE: To investigate the pattern of neuropsychiatric symptoms of MCI patients in the Thai population and the influence of demographic factors on the symptoms. METHODS: One hundred and seven participants aged 50 and over diagnosed with MCI (n = 77) and normal (n = 30) were recruited from a community-based unit. The Neuropsychiatric Inventory (NPI) was used to assess behavioral disturbances in the subjects. RESULTS: Compared to normal subjects, MCI patients had higher incidence of anxiety (53% vs 27%, p = 0.013), dysphoria (46% vs 17%, p = 0.006), and sleep problem (45% vs 23%, p = 0.035). Although marginally significant, apathy was more common in MCI patients (12% vs 0%, p = 0.059). The mean total NPI score and NPI distress score were higher in the MCI group (6.8 vs 1.9, p < 0.0005 and 2.9 vs 0.6, p = 0.01, respectively). The MCI patients aged over 65 had higher incidence of hallucinations (18.9% vs 0%, p = 0.018). Males and patients of poor financial status had higher percentage of dysphoria compared to female and patients with better financial status (65% vs 38.5%, p = 0.041 and 75% vs 37.9%, p = 0.008, respectively). Patients with poor financial status also had higher percentage of anxiety (81.3% vs 44.5%, p = 0.01). CONCLUSIONS: MCI is associated with significant neuropsychiatric symptoms which caused caregiver distress. In this study, the pattern of neuropsychiatric symptoms in a Thai MCI population was similar to those reported in western countries. Age, sex, educational level and financial status influenced the neuropsychiatric symptoms of MCI patients.     

High daytime and nighttime ambulatory pulse pressure predict poor cognitive function and mild cognitive impairment in hypertensive individuals

High blood pressure accelerates normal aging stiffness process. Arterial stiffness (AS) has been previously associated with impaired cognitive function and dementia. Our aims are to study how cognitive function and status (mild cognitive impairment, MCI and normal cognitive aging, NCA) relate to AS in a community-based population of hypertensive participants assessed with office and 24-hour ambulatory blood pressure measurements. Six hundred ninety-nine participants were studied, 71 had MCI and the rest had NCA. Office pulse pressure (PP), carotid–femoral pulse wave velocity, and 24-hour ambulatory PP monitoring were collected. Also, participants underwent a brain magnetic resonance to study cerebral small–vessel disease (cSVD) lesions. Multivariate analysis–related cognitive function and cognitive status to AS measurements after adjusting for demographic, vascular risk factors, and cSVD. Carotid–femoral pulse wave velocity and PP at different periods were inversely correlated with several cognitive domains, but only awake PP measurements were associated with attention after correcting for confounders (beta = −0.22, 95% confidence interval (CI) −0.41, −0.03). All ambulatory PP measurements were related to MCI, which was independently associated with nocturnal PP (odds ratio (OR) = 2.552, 95% CI 1.137, 5.728) and also related to the presence of deep white matter hyperintensities (OR = 1.903, 1.096, 3.306). Therefore, higher day and night ambulatory PP measurements are associated with poor cognitive outcomes.     

Neuropsychological markers of mild cognitive impairment: A clinic based study from urban India

Background:

Mild cognitive impairment (MCI) is a transitional stage between normal aging and dementia. Persons with MCI are at higher risk to develop dementia. Identifying MCI from normal aging has become a priority area of research. Neuropsychological assessment could help to identify these high risk individuals.

Objective:

To examine clinical utility and diagnostic accuracy of neuropsychological measures in identifying MCI.

Materials and Methods:

This is a cross-sectional study of 42 participants (22 patients with MCI and 20 normal controls [NC]) between the age of 60 and 80 years. All participants were screened for dementia and later a detailed neuropsychological assessment was carried out.

Results:

Persons with MCI performed significantly poorer than NC on word list (immediate and delayed recall), story recall test, stick construction delayed recall, fluency and Go/No-Go test. Measures of episodic memory especially word list delayed recall had the highest discriminating power compared with measures of semantic memory and executive functioning.

Conclusion:

Word list learning with delayed recall component is a possible candidate for detecting MCI from normal aging.     

Mild cognitive impairment in adult: A neuropsychological review

Mild cognitive impairment (MCI) is associated with an increased risk of developing dementia. This is clinically relevant overt dementia can be prevented if treatment strategies are devised for MCI. Neuropsychological deficits in this condition are very common and are important clinically for treatment and outcomes. We aimed to review various neuropsychological deficits in MCI. Further, we have presented the current evidence for nosological status, neuroanatomical basis, and clinical outcome of this heterogeneous construct. All published papers on the topic of neuropsychological deficits in MCI on Medline and other databases were reviewed. A wide range of memory and executive function deficits are common in MCI patients. However, several studies are limited by either improper designs or inadequate sample sizes. Several neuropsychological impairments like memory function and executive functions can be diagnosed in MCI. The evidence base for the exact neuroanatomical basis of MCI is not robust yet. However, given the wide range of outcomes, controversies and debates exist regarding the nosological significance of the deficits. Hence, more studies are needed to specifically locate the impairments and further delineate the construct of MCI.     

Neuropsychiatric symptoms in South‐East Asian patients with mild cognitive impairment and dementia: prevalence,subtypes, and risk factors

Background

The subtypes and risk factors of neuropsychiatric symptoms remain largely unexplored in South‐East Asian populations.

Objective

We investigated the prevalence, subtypes, and risk factors, namely, demographic, medical morbidity, and cognitive impairment associated with neuropsychiatric symptoms in a South‐East Asian cohort of patients with mild cognitive impairment (MCI) and dementia.

Methods

A clinical cohort of 38 MCI and 198 mild–moderate dementia patients were assessed using the Neuropsychiatric Inventory‐Questionnaire.

Results

Neuropsychiatric symptoms were equally prevalent among patients with MCI (74%) and mild–moderate dementia (85%). Three subtypes of symptoms were identified for each diagnostic group; for MCI, they included mood disturbances, anxiety/sleep problems, and psychosis, while for dementia, the subtypes included behavioral disturbances, psychosis/mood, and hyperactive behaviors. The largest risk for neuropsychiatric symptoms for both MCI and dementia patients was male gender. Among patients with MCI, burden of cerebrovascular disease and global cognitive impairment were small risks for neuropsychiatric symptoms, while for patients with dementia, an older age (>65 years) was a small risk and lower educational attainment was a moderate risk.

Discussion

These findings contribute to the worldwide epidemiology of neuropsychiatric symptoms in MCI and dementia and highlight that the profile of symptoms, subtypes, and risks is fairly homogenous across Western and Asian cultures. Copyright © 2017 John Wiley & Sons, Ltd.     

Prospective memory function and cue salience in mild cognitive impairment: Findings from the Sydney Memory and Ageing Study

Objective: Prospective memory (PM) is crucial to the maintenance of functional independence in late adulthood and is consistently impaired in mild cognitive impairment (MCI). There remains a need for brief but valid measures of this construct that can be used as part of a comprehensive clinical assessment of cognition. Since the distinctiveness of PM cues is argued to determine the degree of strategic, controlled demands of PM paradigms, two variants of a brief measure were developed, one of which presented low-salience and the other high-salience PM cues.

Method: A large cohort of older adults with normal cognition or MCI was assessed with one of the two variants of our brief, novel measure of PM. Participants were asked to remember to execute PM tasks where the target cue was either high or low in salience, while concurrently engaged in an ongoing task of olfactory assessment.

Results: The task was able to discriminate between groups of participants with MCI or no cognitive impairment, albeit with a small effect size. The high-salience cue improved performance on the PM task; however, there was no interaction of cue salience with group.

Conclusions: These results suggest that the temporal reliability and construct validity of very brief measures of the type used in this study need further exploration to determine their potential to provide meaningful insights into PM function. This measure may have utility as a brief screening tool, with identified deficits being followed up with a more comprehensive PM assessment.     

Mild cognitive impairment in Parkinson's disease: the challenge and the promise

This review addresses the literature surrounding Parkinson's disease (PD) and mild cognitive impairment (MCI). It discusses the neuropsychological, pharmaceutical, and pathological overlap, the socioeconomic impact of PD and MCI, and the value of recognizing, understanding, and treating MCI in PD. It is concluded from this review that MCI in PD does exist and should be considered in clinical and research investigations. Due to the lack of accepted clinical criteria, an inclusive operating definition of MCI in PD is proposed. Research guidelines for studying the presence of MCI in PD and evaluating the efficacy of pharmaceutical interventions are also suggested.     

From mild cognitive impairment to dementia: a prevalence study in a district of Tuscany, Italy

OBJECTIVE: A door-to-door two-phase study was designed in order to estimate the prevalence of cognitive deficit amongst the residents of a district in Tuscany (central Italy). Identification of cases with mild cognitive impairment (MCI) was given high priority, because this condition has been suggested as a term for the boundary area between normal aging and dementia. METHODS: Of the 1600 subjects who completed the screening phase, 354 scored under the cut-off point of the Mini Mental State Examination and Clinical Dementia Rating and were investigated by means of a standardized diagnostic protocol. RESULTS: The prevalence of MCI and age-related cognitive decline was 4.9 and 9.3%, respectively; low levels of education significantly increased the risk of these conditions. The prevalence of dementia over age 65 was 6.2%, with a significant risk association with age. In our population, Alzheimer's disease was the most frequent type of dementia (prevalence rate 4.2%) and increased risk depending on age, sex and education has been found. CONCLUSIONS: Our findings are somewhat similar to previous studies. Further epidemiological and longitudinal studies are warranted to identify which diagnostic category is more predictive for dementia.     

Fat intake at midlife and cognitive impairment later in life: a population-based CAIDE study

OBJECTIVE: To investigate the association of midlife dietary fat intake to cognitive performance, and to the occurrence of clinical mild cognitive impairment (MCI) later in life in a non-demented population. DESIGN: A longitudinal population-based study. SETTING: Populations of Kuopio and Joensuu, Eastern Finland. PARTICIPANTS AND METHODS: Participants of the CAIDE study were derived from random, population-based samples studied at midlife (1972, 1977, 1982 or 1987). After an average follow-up of 21 years, a total of 1449 (72%) individuals aged 65-80 years participated in the re-examination in 1998. Altogether 82 (5.7%) people were diagnosed as having MCI. Dietary information was collected with a structured questionnaire and an interview at midlife. MAIN OUTCOME MEASURES: MCI, global cognitive and executive functions, episodic, semantic and prospective memory and psychomotor speed. RESULTS: Abundant saturated fat (SFA) intake from milk products and spreads at midlife was associated with poorer global cognitive function and prospective memory and with an increased risk of MCI (OR 2.36, 95% CI 1.17-4.74) after adjusting for demographic and vascular factors, other fats and ApoE. On the contrary, high intake of polyunsaturated fatty acids (PUFA) was associated with better semantic memory. Also frequent fish consumption was associated with better global cognitive function and semantic memory. Further, higher PUFA-SFA ratio was associated with better psychomotor speed and executive function. CONCLUSIONS: Our data suggests that dietary fat intake at midlife affects cognitive performance and occurrence of MCI later in life. The impact of dietary interventions needs to be tested in clinical trials.