Prevalence of Neuropsychiatric Symptoms in CIND and Its Subtypes: The Cache County Study

Abstract

Objectives-1) To report rates of neuropsychiatric symptoms (NPS) in cognitive impairment, no dementia (CIND). 2) To compare the 30-day prevalence of NPS in CIND with that in dementia and cognitively normal individuals. 3) To compare the prevalence of NPS in amnestic MCI (aMCI) with other predementia syndromes. Design-Comparison of prevalence proportions among several defined groups. Setting-Population-based study.Participants-A subsample of the permanent residents of Cache County, Utah, aged 65 years or older in January 1995 (N = 5092) and who had completed clinical assessments and had an informant-completed Neuropsychiatric Inventory.Measurements-Chi-square statistics, tests for trend, and logistic regression models were used to analyze the three objectives listed earlier.Results-The most prevalent NPS in those with CIND were depression (16.9%), irritability (9.8%), nighttime behaviors (7.6%), apathy (6.9%), and anxiety (5.4%). Trend analyses confirmed that the CIND group had NPS prevalence rates that fell between the normal and dementia groups for most NPS. Logistic regression models showed no significant difference between aMCI and other CIND participants in the prevalence of any NPS (lowest p: 0.316).Conclusions-These data confirm the relatively high prevalence of NPS in CIND reported by other studies, especially for affective symptoms. No differences in NPS prevalence were found between aMCI and other types of CIND. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptAm J Geriatr Psychiatry. Author manuscript; available in PMC 2013 May 1. NIH-PA Author ManuscriptDementia is increasingly recognized as a serious public health concern.1 Fueled by an aging population and an increased public awareness of the signs and symptoms of dementia, there has been a notable increase in the prevalence of dementia.2 In conjunction with this increase has been a growing focus on individuals with notable cognitive impairment at a severity level insufficient for a diagnosis of dementia.3 The terms "cognitive impairment, no dementia" (CIND) and "mild cognitive impairment" (MCI) have been used to describe the collection of symptoms displayed by these individuals, many of whom are in the prodromal stages to dementia. According to the American Association of Geriatric Psychiatry (AAGP) position statement,4 CIND is a clinical syndrome consisting of measurable or evident decline in memory or other cognitive abilities with little effect on day-to-day functioning that does not meet criteria for dementia listed by Diagnostic and Statistical Manual of Mental Disorders, Fourth Editi...

Neuropsychiatric Symptoms and Cognitive Impairment: Understanding the Importance of Co-Morbid Symptoms

“…As expected, those with MCI and dementia reported the highest prevalence of NPS (53.4% and 80%, respectively). This is consistent with previous reports of NPS in community-based samples of clinical groups, where NPS have been reported in 61%-97% of individuals with dementia [7,8] and 31%-50% of individuals with MCI [4][5][6]8]. These finding are or particular clinical relevance as it is well accepted that the comorbid presentation of NPS in MCI is linked to higher progression to dementia and that for patients with AD, NPS are associated with an increased likelihood of progression from mild to severe dementia [35].…”

“…Most of the studies on NPS to date have focused on highly selective clinical samples recruited from tertiary care centers [12,[23][24][25] or as subsamples of population-based cohorts [4,7,8,14,19,26]. This means that there is a gap in our knowledge about the spectrum of NPS occurring in the population across different cognitive phenotypes, disorders, outcomes, and status.…”

“…Prevalence estimates of NPS are reported among 31%-50% of individuals with MCI [4][5][6] and 61%-97% of individuals with dementia [7,8]. It is well accepted that the comorbid presentation of NPS in MCI is linked to higher progression to dementia [9][10][11][12][13][14][15] and that for patients with Alzheimer's disease (AD), NPS are associated with an increased likelihood of progression from mild to severe dementia [16].…”

Neuropsychiatric Symptoms as Risk Factors for Progression From CIND to Dementia: The Cache County Study

“…We did not observe similar associations for conversion from aMCI to dementia. We recently reported that the prevalence of NPS in aMCI is comparable to CIND 10 , so the lack of significant results for the aMCI subgroup analysis is likely a result of inadequate sample size.…”

“…As a result, and because NPS are associated with a worse prognosis in dementia 9 , the occurrence of NPS in MCI/CIND has become of interest to clinicians and researchers. In a recent population-based study using data from the Cache County Study of Memory Health and Aging (CCSMHA), we estimated the prevalence of NPS in individuals with CIND and MCI 10 . Thirty-one percent of participants with CIND had at least one NPS, a rate halfway between that in the cognitively normal (15%) and those with dementia (60%).…”