Neuropsychiatric symptoms and cognition: An observational study in a Filipino memory clinic setting

Abstract

Background A growing body of evidence has described neuropsychiatric symptoms (NPS) as early markers of cognitive decline and may precede onset of measurable neurocognitive changes.1,2 NPS have been associated with accelerated cognitive decline and higher dementia conversion rates.3 The repeated observation that individuals with NPS are at increased risk of further cognitive decline delineates this group as high risk and suitable for early interventions to prevent cognitive and functional loss.4 The objectives are to determine the prevalence and compare the demographic and cognitive profiles of non‐demented individuals with NPS in a Filipino cohort. Method A total of 435 patients with no cognitive impairment (NCI) and Mild Cognitive Impairment (MCI) from St. Luke’s Medical Center Memory Clinic were included. NPS were assessed by administration of the Neuropsychiatric Inventory Questionnaire (NPI‐Q) to a reliable caregiver. Participants were administered the Mini‐Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Alzheimer’s Disease Assessment Scale Cognitive Subscale (ADAS‐Cog). Result Compared to patients without NPS, patients with NPS have more impaired cognition with lower MMSE (25 + 4 vs 27 + 3, p=0.001); MoCA (21 + 5 vs 23 + 5, p=0.002) and higher ADAS‐Cog scores (12.4.6 + 6 vs 10.6 + 6, p=0.01). A fully adjusted model showed NPS to be significantly associated with MMSE (‐0.8, 95% CI ‐1.6 to ‐0.02, p=0.04) and MoCA scores (‐1.2, 95% CI ‐2.3 to ‐0.2, p=0.02). Conclusion This study shows that non‐demented individuals with NPS have more cognitive impairment suggesting the importance of NPS as a potential marker for early cognitive decline and a need for further trials that targets treatment for NPS even at an early stage to prevent cognitive impairment.