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Neuropsychiatric Symptom Clusters and Functional Disability in Cognitively-Impaired-Not-Demented Individuals

From the Department of Psychology, Trent University, Peterborough, Ontario, Canada (KRP); the Divisions of Geriatric Medicine and Neurology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada (KR); the Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada (SEB); the Division of Geriatric Medicine, Department of Medicine, University of Calgary, Calgary, Alberta, Canada (DBH); the Departments of Neurology and Neurosurgery, Psychiatry, Medicine, McGill University, Montreal, Quebec, Canada (SGG); the Division of Neurology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada (IL-E); the Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (G-YRH, CJ, HHF); and the Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada (AK).

Objective: Previous research has shown that cognitively-impaired-not-demented (CIND) individuals with at least one neuropsychiatric symptom (NPS) have more functional disability than individuals without any NPSs. The objectives of the present study were to determine whether there are consistent clusters of NPS in CIND individuals and whether certain NPS clusters are more strongly associated with measures of functional disability than other NPS clusters in this population.

Methods: This was a cross-sectional baseline study of NPS using the Neuropsychiatric Inventory (NPI) in a national clinic-based observational cohort study (the Canadian Cohort Study of Cognitive Impairment and Related Dementias study). The present investigation focuses on a subset of CIND subjects (73%) whose informant endorsed the presence of at least one NPI item.

Results: A hierarchical cluster analysis identified two NPS clusters. One consisted of mood factors (i.e., depression, anxiety, apathy, irritability, and problems with sleep) and the other cluster captured frontal symptoms (i.e., aberrant motor behavior, disinhibition, agitation, and problems with appetite). NPSs grouped within the mood cluster were more common than the frontal cluster (95% of subjects had at least one NPS within the mood cluster versus 53% in the frontal cluster). However, the frontal cluster was more strongly associated with functional disability measures even after controlling for cognitive status (i.e., the Mini-Mental State Exam) and the mood cluster score.

Conclusion: The frontal cluster of NPSs was more strongly associated with functional disability than the mood cluster.

Key Words: neuropsychiatric symptoms • functional disability • cognitive impairment

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