Baseline Neuropsychiatric Symptoms and the Risk of Incident Mild Cognitive Impairment: A Population-Based Study
Abstract
Objective
Method
Results
Conclusions
Method
Setting
Cognitive Evaluation
Mild Cognitive Impairment Criteria
Mild Cognitive Impairment Subtypes
Neuropsychiatric Assessment
Statistical Analyses
Results
Characteristic | Total (N=1,408) | Depression Cohort (N=153) | Apathy Cohort (N=57) | Anxiety Cohort (N=66) | Agitation Cohort (N=33) | Irritability Cohort (N=96) | Appetite/Eating Cohort (N=67) | Motor Disturbance Cohort (N=7) | Nighttime Behaviors Cohorta (N=122) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
N | % | N | % | N | % | N | % | N | % | N | % | N | % | N | % | N | % | |
Male | 704 | 50.0 | 72 | 47.1 | 33 | 57.9 | 28 | 42.4 | 20 | 60.6 | 62 | 64.6 | 3 | 64.2 | 4 | 57.1 | 68 | 55.7 |
Median | Interquartile Range | Median | Interquartile Range | Median | Interquartile Range | Median | Interquartile Range | Median | Interquartile Range | Median | Interquartile Range | Median | Interquartile Range | Median | Interquartile Range | Median | Interquartile Range | |
Age (years) | 79.3 | 75.0–83.4 | 79.8 | 75.2–83.6 | 79.1 | 76.2–82.7 | 81.3 | 75.9–83.9 | 79.1 | 75.3–82.7 | 79.3 | 75.1–83.3 | 81.5 | 76.9–84.3 | 79.4 | 72.8–83.1 | 80.2 | 75.2–82.6 |
N | % | N | % | N | % | N | % | N | % | N | % | N | % | N | % | N | % | |
70–79 | 741 | 52.6 | 79 | 51.6 | 31 | 54.4 | 30 | 45.5 | 20 | 60.6 | 52 | 54.2 | 27 | 40.3 | 4 | 57.1 | 61 | 50.0 |
80–91 | 667 | 47.4 | 74 | 48.4 | 26 | 45.6 | 36 | 54.5 | 13 | 39.4 | 44 | 45.8 | 40 | 59.7 | 3 | 42.9 | 61 | 50.0 |
Median | Interquartile Range | Median | Interquartile Range | Median | Interquartile Range | Median | Interquartile Range | Median | Interquartile Range | Median | Interquartile Range | Median | Interquartile Range | Median | Interquartile Range | Median | Interquartile Range | |
Education (years) | 13 | 12–16 | 12 | 12–15 | 13 | 12–16 | 13 | 12–16 | 13 | 12–16 | 13 | 12–16 | 13 | 12–16 | 12 | 12–17 | 13 | 12–16 |
N | % | N | % | N | % | N | % | N | % | N | % | N | % | N | % | N | % | |
>12 | 801 | 56.9 | 74 | 48.4 | 29 | 50.9 | 36 | 54.5 | 20 | 60.6 | 50 | 52.1 | 38 | 56.7 | 3 | 42.9 | 70 | 57.4 |
Median | Interquartile Range | Median | Interquartile Range | Median | Interquartile Range | Median | Interquartile Range | Median | Interquartile Range | Median | Interquartile Range | Median | Interquartile Range | Median | Interquartile Range | Median | Interquartile Range | |
Charlson comorbidity index score | 3 | 1–5 | 3 | 2–5 | 4 | 2–8 | 3 | 2–5 | 4 | 2–6 | 3 | 1–5 | 4 | 2–7 | 2 | 2–6 | 3 | 2–6 |
Time in study (years) | 5.03 | 5.3–8.0 | 4.5 | 2.9–5.2 | 4.1 | 2.7–5.2 | 4.5 | 3.2–5.2 | 4.3 | 3.1–5.2 | 4.6 | 2.9–5.2 | 4.5 | 3.6–5.3 | 4.1 | 3.9–5.3 | 5.1 | 3.1–5.3 |
N | % | N | % | N | % | N | % | N | % | N | % | N | % | N | % | N | % | |
Incident mild cognitive impairment | 364 | 25.9 | 59 | 38.6 | 25 | 43.9 | 30 | 45.5 | 18 | 54.5 | 38 | 39.6 | 25 | 37.3 | 3 | 42.9 | 38 | 31.1 |
Incidence Rate | 95% CI | Incidence Rate | 95% CI | Incidence Rate | 95% CI | Incidence Rate | 95% CI | Incidence Rate | 95% CI | Incidence Rate | 95% CI | Incidence Rate | 95% CI | Incidence Rate | 95% CI | Incidence Rate | 95% CI | |
Incidence rateb | 68 | 61–76 | 109 | 83–141 | 142 | 92–210 | 138 | 93–197 | 186 | 110–295 | 119 | 85–164 | 103 | 67–152 | 116 | 24–338 | 86 | 61–118 |
Characteristic | Disinhibition Cohort (N=22) | Euphoria Cohort (N=7) | Delusions Cohort (N=5) | Hallucinations Cohort (N=5) | ||||
---|---|---|---|---|---|---|---|---|
N | % | N | % | N | % | N | % | |
Male | 12 | 54.5 | 3 | 42.9 | 2 | 40.0 | 3 | 60.0 |
Median | Interquartile Range | Median | Interquartile Range | Median | Interquartile Range | Median | Interquartile Range | |
Age (years) | 80.3 | 76.2–84.3 | 81.3 | 78.0–82.0 | 80.9 | 78.4–83.5 | 86.2 | 82.7–86.8 |
N | % | N | % | N | % | N | % | |
70–79 | 9 | 40.9 | 3 | 42.9 | 2 | 40.0 | 0 | 0.0 |
80–91 | 13 | 59.1 | 4 | 57.1 | 3 | 60.0 | 5 | 100.0 |
Median | Interquartile Range | Median | Interquartile Range | Median | Interquartile Range | Median | Interquartile Range | |
Education (years) | 12 | 12–14 | 16 | 13–16 | 13 | 13–15 | 13 | 13–14 |
N | % | N | % | N | % | N | % | |
>12 | 10 | 45.5 | 6 | 85.7 | 4 | 80.0 | 4 | 80.0 |
Median | Interquartile Range | Median | Interquartile Range | Median | Interquartile Range | Median | Interquartile Range | |
Charlson comorbidity index score | 3.5 | 2–5 | 4 | 3–4 | 3 | 1–5 | 4 | 4–5 |
Time in study (years) | 3.0 | 2.6–5.2 | 5.4 | 3.1–5.4 | 2.7 | 2.7–5.2 | 2.9 | 2.7–4.2 |
N | % | N | % | N | % | N | % | |
Incident mild cognitive impairment | 11 | 50.0 | 6 | 85.7 | 1 | 20.0 | 2 | 40.0 |
Incidence Rate | 95% CI | Incidence Rate | 95% CI | Incidence Rate | 95% CI | Incidence Rate | 95% CI | |
Incidence ratea | 177 | 89–317 | 265 | 97–576 | 55 | 1–308 | 162 | 20–583 |
Secondary Analyses
Psychiatric Symptom | Risk Adjusted for Age (Time Scale), Sex, and Education | Risk Additionally Adjusted for Medical Comorbidity | ||||
---|---|---|---|---|---|---|
Hazard Ratio | 95% CI | p | Hazard Ratio | 95% CI | p | |
Total mild cognitive impairment | ||||||
Depression | 1.68 | 1.27–2.22 | <0.001 | 1.63 | 1.23–2.16 | <0.001 |
Apathy | 2.46 | 1.63–3.70 | <0.001 | 2.26 | 1.49–3.41 | <0.001 |
Anxiety | 1.91 | 1.31–2.78 | <0.001 | 1.87 | 1.28–2.73 | 0.001 |
Agitation | 3.13 | 1.94–5.05 | <0.001 | 3.06 | 1.89–4.93 | <0.001 |
Irritability | 1.85 | 1.32–2.60 | <0.001 | 1.84 | 1.31–2.58 | <0.001 |
Appetite/eating | 1.44 | 0.96–2.17 | 0.08 | 1.34 | 0.89–2.02 | 0.16 |
Motor disturbance | 1.63 | 0.52–5.11 | 0.40 | 1.60 | 0.51–5.00 | 0.42 |
Nighttime behaviorsa | 1.48 | 1.05–2.08 | 0.03 | 1.46 | 1.03–2.06 | 0.03 |
Amnestic mild cognitive impairment | ||||||
Depression | 1.75 | 1.23–2.48 | 0.002 | 1.74 | 1.22–2.47 | 0.002 |
Apathy | 1.98 | 1.13–3.47 | 0.02 | 1.93 | 1.09–3.41 | 0.02 |
Anxiety | 1.65 | 0.99–2.76 | 0.05 | 1.64 | 0.98–2.74 | 0.06 |
Agitation | 2.18 | 1.07–4.44 | 0.03 | 2.16 | 1.06–4.41 | 0.03 |
Irritability | 1.69 | 1.09–2.64 | 0.02 | 1.69 | 1.08–2.63 | 0.02 |
Appetite/eating | 1.09 | 0.61–1.95 | 0.78 | 1.06 | 0.59–1.91 | 0.85 |
Motor disturbance | 0.84 | 0.12–6.01 | 0.86 | 0.84 | 0.12–5.97 | 0.86 |
Nighttime behaviorsa | 1.44 | 0.93–2.24 | 0.11 | 1.44 | 0.93–2.25 | 0.10 |
Nonamnestic mild cognitive impairment | ||||||
Depression | 1.26 | 0.68–2.31 | 0.46 | 1.18 | 0.64–2.16 | 0.60 |
Apathy | 3.81 | 1.97–7.38 | <0.001 | 3.19 | 1.62–6.26 | <0.001 |
Anxiety | 2.84 | 1.50–5.35 | 0.001 | 2.74 | 1.45–5.16 | 0.002 |
Agitation | 5.14 | 2.46–10.7 | <0.001 | 4.92 | 2.36–10.3 | <0.001 |
Irritability | 2.18 | 1.18–4.02 | 0.01 | 2.18 | 1.18–4.03 | 0.01 |
Appetite/eating | 1.52 | 0.70–3.30 | 0.29 | 1.31 | 0.60–2.85 | 0.50 |
Motor disturbance | 4.12 | 1.00–16.9 | <0.05 | 3.89 | 0.94–16.0 | 0.06 |
Nighttime behaviorsa | 2.11 | 1.15–3.88 | 0.02 | 2.04 | 1.11–3.76 | 0.02 |
Psychiatric Symptom | Risk Adjusted for Age (Time Scale), Sex, and Education | Risk Additionally Adjusted for Medical Comorbidity | ||||
---|---|---|---|---|---|---|
Hazard Ratio | 95% CI | p | Hazard Ratio | 95% CI | p | |
Total mild cognitive impairment | ||||||
Disinhibition | 2.60 | 1.42–4.75 | 0.002 | 2.59 | 1.42–4.73 | 0.002 |
Euphoria | 5.07 | 2.23–11.5 | <0.001 | 5.10 | 2.24–11.6 | <0.001 |
Delusions | 0.60 | 0.08–4.27 | 0.61 | 0.55 | 0.08–3.95 | 0.55 |
Hallucinations | 1.57 | 0.39–6.37 | 0.52 | 1.48 | 0.37–5.99 | 0.58 |
Amnestic mild cognitive impairment | ||||||
Disinhibition | 1.49 | 0.55–4.01 | 0.43 | 1.48 | 0.55–4.00 | 0.44 |
Euphoria | 2.42 | 0.59–9.84 | 0.22 | 2.41 | 0.59–9.83 | 0.22 |
Delusions | 1.02 | 0.14–7.34 | 0.98 | 1.00 | 0.14–7.15 | 1.00 |
Hallucinations | 1.32 | 0.18–9.52 | 0.78 | 1.30 | 0.18–9.34 | 0.80 |
Nonamnestic mild cognitive impairment | ||||||
Disinhibition | 5.22 | 2.26–12.0 | <0.001 | 5.18 | 2.24–12.0 | <0.001 |
Euphoria | 10.7 | 3.27–35.1 | <0.001 | 11.3 | 3.44–37.2 | <0.001 |
Delusionsa | 0.99 | 0.99 | ||||
Hallucinations | 3.10 | 0.42–22.7 | 0.27 | 2.76 | 0.38–20.3 | 0.32 |
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