Neuropsychiatric Symptoms as Risk Factors for Cognitive Decline in Clinically Normal Older Adults: The Cache County Study |
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| Affiliation: | 1. Johns Hopkins University School of Medicine, Baltimore, MD;2. Utah State University, Logan, UT;1. Department of Nursing, XiangYa School of Medicine, Central South University, Changsha, China;2. Department of Hematology, Tumor Hospital of Henan Province, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, China;3. Department of Public Health, XiangYa School of Medicine, Central South University, Changsha, China;4. Department of Nursing, Xinjiang Medical University, Xinjiang, China;5. Henan Provincial People''s Hospital, Zhengzhou, China;6. Oceanwide Health management institute, Central South University, Changsha, China;1. Center for Cognitive Medicine, Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN;2. Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC;3. Department of Psychiatry, University of Connecticut Health Center, Farmington, CT;4. Geriatric Research, Education and Clinical Center, Department of Veterans Affairs Medical Center (WDT), Tennessee Valley Healthcare System, Nashville, TN;1. Johns Hopkins University School of Medicine (ASK), Baltimore, MD;2. Cochlear Center for Hearing and Public Health (ASK, EEGM, FRL, NSR, ESO, CLN), Baltimore, MD;3. Division of Geriatric Medicine and Gerontology (HA, SY, ESO), Johns Hopkins University School of Medicine, Baltimore, MD;4. Johns Hopkins University School of Nursing (VTC, ESO), Baltimore, MD;5. Department of Otolaryngology-Head and Neck Surgery (FRL, CLN), Johns Hopkins University School of Medicine, Baltimore, MD;6. Department of Psychiatry and Behavioral Sciences (CGL, MAN, ESO), Johns Hopkins Bayview and Johns Hopkins University, Baltimore, MD;7. Department of Communication Disorders (SKM), University of Massachusetts Amherst, Amherst, MD;8. Department of Epidemiology (NSR), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD;1. MET GGZ Maastricht (BG), Regional Institute for Mental Health Care in Outpatients, Maastricht, Netherlands;2. Department of Psychiatry and Neuropsychology (BG, MPJvB, FRJV, SK), School for Mental Health and Neuroscience and Alzheimer Centre Limburg, Maastricht University Medical Center+, Maastricht, Netherlands;3. Center for Psychiatry & Interdisciplinary Center of Psychopathology of Emotion Regulation (RCOV), University Medical Center Groningen, Groningen, Netherlands |
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| Abstract: | IntroductionThere has been considerable progress in identifying early cognitive and biomarker predictors of Alzheimer's disease (AD). Neuropsychiatric symptoms (NPS) are common in AD and appear to predict progression after the onset of mild cognitive impairment or dementia.ObjectivesThe objective of the study is to examine the relationship between NPS in clinically normal older adults and subsequent cognitive decline in a population-based sample.MethodsThe Cache County Study on Memory in Aging consists of a population-based sample of 5,092 older adults. We identified 470 clinically normal adults who were followed for an average period of 5.73 years. NPS were evaluated at the baseline clinical assessment using the Neuropsychiatric Inventory (NPI). NPI domain scores were quantified as the product of frequency X severity in individual NPI domains, and then summed for the NPI-Total. Neuropsychological measures were collected at baseline and at each subsequent follow-up wave. Linear mixed-effects models assessed the association of NPI-Total, NPI-Depression, and NPI-Anxiety scores (obtained at baseline) on longitudinal change in neuropsychological performance, controlling for age, sex, and education.ResultsBaseline NPI-Total score was associated with a more rapid rate of decline in word list memory, praxis recall, and animal fluency. Baseline NPI-Depression was not associated with later decline on any of the cognitive tests, while baseline NPI-Anxiety was associated with decline in Symbol Digit Modality.ConclusionIn conclusion, among clinically normal older adults derived from this population-based study, total burden of NPS was associated with longitudinal cognitive decline. These results add to the evidence that NPS are risk factors for or clinical indicators of preclinical dementia syndrome. Our study was an exploratory study and we did not control for multiple comparisons. |
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