We explored the influence of study partner (SP) characteristics on SP-reported neuropsychiatric symptoms (NPS) presence across the neurocognitive spectrum and on the prognostic utility of mild behavioral impairment (MBI).

We performed cross-sectional (n = 26,748) and longitudinal (n = 12,794) analyses using participant-SP dyad data from the National Alzheimer’s Coordinating Center. Participants were cognitively normal (CN; n = 11,951) or had mild cognitive impairment (MCI; n = 5686) or dementia (n = 9111).

SPs rated NPS using the Neuropsychiatric Inventory Questionnaire. We used multivariable logistic regression to model the association between SP characteristics (age, sex, and relationship to participant [spouse, child, and other]) and NPS status (outcome). Cox regressions assessed SP characteristics as moderators of MBI associations with incident dementia or as predictors of incident dementia in MBI + participants only.

Among CN persons, younger, female, and spouse SPs reported NPS more frequently. In MCI, younger SPs and those who were spouses or children of participants reported higher NPS odds. For dementia participants, NPS odds were higher in female and spouse SPs. MBI associations with incident dementia were slightly weaker when SPs were older but did not depend on SP sex or relationship to participant. Among MBI + participants with spouse or child SPs, hazard for dementia was higher when compared to MBI + participants with other SPs.

SP age, sex, and relationship to participant influence NPS reporting across the neurocognitive spectrum, with potential implications for MBI prognosis. Considering SP characteristics may enhance the accuracy of NPS assessments, which may facilitate therapy planning and prognosis.

Among people with dementia, poor nutritional status has been associated with worse cognitive and functional decline, but few studies have examined its association with neuropsychiatric symptoms (NPS). We examined this topic in a population-based sample of persons with dementia.

Longitudinal, observational cohort study.

Community.

Two hundred ninety-two persons with dementia (71.9% Alzheimer’s disease, 56.2% women) were followed up to 6 years.

We used a modified Mini-Nutritional Assessment (mMNA) and the Neuropsychiatric Inventory (NPI) to evaluate nutritional status and NPS, respectively. Individual linear mixed effects models examined the associations between time-varying mMNA total score or clinical categories (malnourishment, risk for malnourishment, or well-nourished) and NPI total score (excluding appetite domain) or NPI individual domain or cluster (e.g. psychosis) scores. Covariates tested were dementia onset age, type, and duration, medical comorbidities, sex, apolipoprotein E (APOE) genotype, and education.

Compared to the well-nourished, those at risk for malnourishment and those malnourished had higher total NPI scores [b (95% CI) = 1.76 (0.04, 3.48) or 3.20 (0.62, 5.78), respectively], controlling for significant covariates. Higher mMNA total score (better nutritional status) was associated with lower total NPI [b (95% CI) = −0.58 (−0.86, −0.29)] and lower domain scores for psychosis [b (95% CI) = −0.08 (−0.16, .004)], depression [b (95% CI = −0.11 (−0.16, −0.05], and apathy [b (95% CI = −0.19 (−0.28, −0.11)].

Worse nutritional status is associated with more severe NPS. Dietary or behavioral interventions to prevent malnutrition may be beneficial for persons with dementia.

Exploration of the themes and content of psychotic symptoms in young-onset dementia (YOD) is limited to case analysis. The primary objective of this study was to determine the themes of psychotic symptoms in individuals diagnosed with YOD.

Comprehensive retrospective file review of discharge summaries.

Neuropsychiatry, a specialist mental health service located at the Royal Melbourne Hospital, Australia.

Inpatients at Neuropsychiatry admitted between 2018 and 2020 (inclusive).

Data extracted included descriptions and prevalence of psychotic symptoms as well as general demographic and clinical data. Data analysis was conducted using a thematic approach.

Twenty-three inpatients had a diagnosis of YOD with psychotic symptoms. Themes were identified in the domains of delusions (six themes), auditory hallucinations (five themes), and visual hallucinations (two themes). Strong recurring themes across the modalities of hallucinations and delusions were beliefs and experiences relating to paranoia, suspicion, harm, and abuse. Themes did not clearly intersect across the modalities of hallucinations and delusions. A degree of thematic heterogeneity existed within individuals, and individuals experienced delusions or hallucinations of multiple themes. The themes of the psychotic symptoms did not clearly relate to diagnostic category, nor to time from diagnosis.

This study is the first thematic analysis of psychotic symptoms in YOD and provides further understanding of patient phenomenology and experiences of psychosis in YOD.

The International Psychogeriatric Association (IPA) published a provisional consensus definition of agitation in cognitive disorders in 2015. As proposed by the original work group, we summarize the use and validation of criteria in order to remove “provisional” from the definition.

This report summarizes information from the academic literature, research resources, clinical guidelines, expert surveys, and patient and family advocates on the experience of use of the IPA definition. The information was reviewed by a working group of topic experts to create a finalized definition.

We present a final definition which closely resembles the provisional definition with modifications to address special circumstances. We also summarize the development of tools for diagnosis and assessment of agitation and propose strategies for dissemination and integration into precision diagnosis and agitation interventions.

The IPA definition of agitation captures a common and important entity that is recognized by many stakeholders. Dissemination of the definition will permit broader detection and can advance research and best practices for care of patients with agitation.

Apathy is a common symptom in mild cognitive impairment (MCI) and may predict progression to dementia. Little research, however, has investigated the longitudinal trajectory of apathy in patients with MCI or controlled for depression, which can mimic apathy, when examining its clinical correlates. The current study sought to address these issues.

A prospective longitudinal study was conducted over 3 years.

Nine memory clinics around Australia

One hundred and eighty-five patients with MCI at baseline.

Measures of cognition, function, neuropsychiatric symptoms, caregiver burden, and medication use were completed annually with additional assessments at 3 and 6 months. Patients were also assessed for dementia by expert clinicians at these time points.

Of 164 patients who completed measures of neuropsychiatric symptoms, 59 (36.0%) had apathy and 61 (37.2%) had depression. The proportion affected by apathy and overall apathy scores increased over time, in contrast to measures of depression, which remained relatively stable. Apathy was associated with incident dementia and worse cognition, function, neuropsychiatric symptoms, and caregiver burden independent of both depression and incident dementia. Depression was associated with worse function, albeit to lesser degree than apathy, and neuropsychiatric symptoms.

Apathy increases in MCI and is associated with worse clinical outcomes. These findings provide further evidence for apathy as a marker of clinical decline in older people and poorer outcomes across neurocognitive disorders.

This study investigated the views of people living with dementia and their families/care partners on (i) what they find helpful or unhelpful regarding behavioral changes, i.e. which coping strategies they used for themselves and/or which responses from others, and (ii) what they consider to be appropriate terminology to describe behavioral changes.

One-on-one semi-structured interviews were conducted with people living with dementia and families/care partners face to face, online, or over the telephone.

Data from open-ended questions were analyzed inductively. Common themes were derived from the data using an iterative approach.

Twenty-one people living with dementia and 20 family members/care partners were interviewed. Four main themes were derived for helpful responses, and three main themes for unhelpful responses. Helpful responses included providing clear professional support pathways and supportive environments where people living with dementia can engage in physical, cognitive, social, and spiritual activities. Unhelpful responses included discriminatory treatment from others and use of medicalized terminology. Views toward terminology varied; people with lived experience most favored using “changed behaviors” over other terminology. Areas for improvement included targeting dementia stigma, societal education on dementia, and building confidence in people living with dementia by focusing on living well with dementia.

Knowledge of the views of people living with dementia may assist healthcare professionals to provide more appropriate care for people living with dementia.

No significant relationships.

Mild behavioral impairment (MBI) is a neurobehavioral syndrome characterized by later-life emergent neuropsychiatric symptoms, which represent an at-risk state for incident cognitive decline and dementia.

Our obective was to prospectively evaluate the impact of MBI on global functioning in patients ≥ 50 years with a major depressive episode (MDE) at baseline.

We recruited 51 patients ≥ 50 years presenting with a MDE at the outpatient clinic of the 2nd Psychiatric Unit of the University of Pisa. Then we selected those patients who had a follow-up of at least two months and excluded subjects with a neurodegenerative disease. The included patients (N = 25) were subdivided in a subgroup with MBI and a subgroup without MBI. The subgroups have been compared for the difference between baseline and follow-up score in global functioning according Global Assessment of Functioning (GAF) scale. Comparative analyses were conducted by means of mixed anova.

There was a significant interaction effect between time and the MBI condition (F[1, 23] = 4.12, p = 0.05 η p 2 = 0.15). Descriptive statistics showed that while patients without MBI showed higher GAF score at follow-up (mean = 65.12) compared to GAF score at baseline (mean = 54.37), patients with MBI showed, on average, the same GAF score at follow-up (mean = 54.44) and at baseline (mean = 54.44).

In patients with MDE, the presence of MBI is related to a lack of improvement in psychological, social, and occupational functioning in the short-term

No significant relationships.

Huntington’s disease (HD) is a rare (1-9/100 000), inherited disease characterized by an elongated CAG repeat on chromosome 4p, leading to a degeneration of neurons. Also, psychiatric symptoms are very common in the early stage and may appear before motor symptoms.

To characterize neuropsychiatric symptoms in a group of individuals with manifest or pre-motor Huntington’s disease in Medellín, Colombia.

Data obtained from clinical records of individuals with HD (motor-manifest or pre-motor with triplets count) evaluated for ENROLL-HD project in the Group of Neuroscience of Antioquia. We explored variables related to substances abuse, neuropsychiatric symptoms, the respective age of onset, sex, and triplet count when available.

Twenty-six (53%) were women, 8% had a familiar history of psychotic illness in a first-degree relative and 88% presented motor symptoms. Also, 59% had a history of depression, 53% irritability, 57% aggressiveness, 34% apathy, 29% perseverative/obsessive behavior, 14% psychosis, and 30% mild cognitive impairment. Ten individuals (20%) had motor without neuropsychiatric symptoms. Also, thirty-seven individuals (76%) presented motor and neuropsychiatric symptoms; of these, 41% had neuropsychiatric symptoms before motor symptoms. No psychiatric symptoms were associated with the use of alcohol, cigarettes, or drugs of abuse.

Neuropsychiatric symptoms are highly prevalent among individuals with HD and studies oriented to create relevant knowledge for the development of advice oriented to people with this disease are necessary.

No significant relationships.

Certain neuropsychiatric symptoms (NPS), namely apathy, depression and anxiety demonstrated great value in predicting dementia progression representing eventually an opportunity window for timely diagnosis and treatment. However, sensitive and objective markers of these symptoms are still missing.

To investigate the association between automatically extracted speech features and NPS in early-stage dementia patients.

Speech of 141 patients aged 65 or older with neurocognitive disorder was recorded while performing two short narrative speech tasks. Presence of NPS was assessed by the Neuropsychiatric Inventory. Paralinguistic markers relating to prosodic, formant, source, and temporal qualities of speech were automatically extracted, correlated with NPS. Machine learning experiments were carried out to validate the diagnostic power of extracted markers.

Different speech variables seem to be associated with specific neuropsychiatric symptoms of dementia; apathy correlates with temporal aspects, anxiety with voice quality and this was mostly consistent between male and female after correction for cognitive impairment. Machine learning regressors are able to extract information from speech features and perform above baseline in predicting anxiety, apathy and depression scores.

Different NPS seem to be characterized by distinct speech features which in turn were easily extractable automatically from short vocal tasks. These findings support the use of speech analysis for detecting subtypes of NPS. This could have great implications for future clinical trials.

No significant relationships.

In behavioral variant frontotemporal dementia (bvFTD) neuropsychiatric symptoms are a significant concern as they impact care management and caregiver wellbeing.

To describe change in individual neuropsychiatric symptoms and associated caregivers’ distress assessed by the Neuropsychiatry Inventory (NPI) in patients diagnosed with bvFTD and Alzheimer’s disease (AD) from baseline to a 12-month follow-up.

The sample consisted of 31 patients diagnosed with bvFTD and 28 patients with AD and their caregivers. The NPI and the Addenbrooke´s Cognitive Examination Revised (ACE-R) were applied. Descriptive statistics, Mann-Whitney U test, Wilcoxon test, Chi square (χ2) were used.

At baseline, significantly higher scores were observed for the bvFTD group for: agitation, disinhibition and eating disturbances. The latter two were also higher in the NPI Distress subdomains. At followup, there were significantly higher scores for the bvFTD group in agitation, disinhibition, eating disturbances, hallucination and irritability. For the NPI Distress subdomains, agitation, eating disturbances and hallucination scores were significantly higher for the bvFTD group.

In 12 months, neuropsychiatric symptoms increased in both bvFTD and AD groups. However, NPI subdomain and caregiver distress scores were statistically higher among bvFTD patients at both assessment points. Neuropsychiatric symptoms may be associated with care burden in bvFTD and should be a focal point in care management decisions.

No significant relationships.

Neuropsychiatric symptoms are related to disease progression and cognitive decline over time in cerebral small vessel disease (SVD) but their significance is poorly understood in covert SVD. We investigated neuropsychiatric symptoms and their relationships between cognitive and functional abilities in subjects with varying degrees of white matter hyperintensities (WMH), but without clinical diagnosis of stroke, dementia or significant disability.

The Helsinki Small Vessel Disease Study consisted of 152 subjects, who underwent brain magnetic resonance imaging (MRI) and comprehensive neuropsychological evaluation of global cognition, processing speed, executive functions, and memory. Neuropsychiatric symptoms were evaluated with the Neuropsychiatric Inventory Questionnaire (NPI-Q, n = 134) and functional abilities with the Amsterdam Instrumental Activities of Daily Living questionnaire (A-IADL, n = 132), both filled in by a close informant.

NPI-Q total score correlated significantly with WMH volume (r s = 0.20, p = 0.019) and inversely with A-IADL score (r s = −0.41, p < 0.001). In total, 38% of the subjects had one or more informant-evaluated neuropsychiatric symptom. Linear regressions adjusted for age, sex, and education revealed no direct associations between neuropsychiatric symptoms and cognitive performance. However, there were significant synergistic interactions between neuropsychiatric symptoms and WMH volume on cognitive outcomes. Neuropsychiatric symptoms were also associated with A-IADL score irrespective of WMH volume.

Neuropsychiatric symptoms are associated with an accelerated relationship between WMH and cognitive impairment. Furthermore, the presence of neuropsychiatric symptoms is related to worse functional abilities. Neuropsychiatric symptoms should be routinely assessed in covert SVD as they are related to worse cognitive and functional outcomes.

This study examined the effectiveness of an integrated care pathway (ICP), including a medication algorithm, to treat agitation associated with dementia.

Analyses of data (both prospective and retrospective) collected during routine clinical care.

Geriatric Psychiatry Inpatient Unit.

Patients with agitation associated with dementia (n = 28) who were treated as part of the implementation of the ICP and those who received treatment-as-usual (TAU) (n = 28) on the same inpatient unit before the implementation of the ICP. Two control groups of patients without dementia treated on the same unit contemporaneously to the TAU (n = 17) and ICP groups (n = 36) were included to account for any secular trends.

ICP.

Cohen Mansfield Agitation Inventory (CMAI), Neuropsychiatric Inventory Questionnaire (NPIQ), and assessment of motor symptoms were completed during the ICP implementation. Chart review was used to obtain length of inpatient stay and rates of psychotropic polypharmacy.

Patients in the ICP group experienced a reduction in their scores on the CMAI and NPIQ and no changes in motor symptoms. Compared to the TAU group, the ICP group had a higher chance of an earlier discharge from hospital, a lower rate of psychotropic polypharmacy, and a lower chance of having a fall during hospital stay. In contrast, these outcomes did not differ between the two control groups.

These preliminary results suggest that an ICP can be used effectively to treat agitation associated with dementia in inpatients. A larger randomized study is needed to confirm these results.

To explore differences in prevalence and disturbance of behavioral and psychological symptoms of dementia (BPSD) between institution-dwelling and community-dwelling patients with dementia.

A cross-sectional survey was conducted. Institution-dwelling (n=112) and community-dwelling patients with dementia (n=157) were enrolled from a nursing home and a tertiary psychiatric hospital located in Guangzhou, China, from March 2019 to September 2019. Neuropsychiatric Inventory (NPI) was used to assess the prevalence and disturbance of BPSDs.

The community-dwelling patients were older, and having more antianxiety, anticonvulsant, anti- depression, anti-dementia medication use than institution-dwelling patients, while institution-dwelling patients used more antipsychotics than community-dwelling patients. The prevalence of hallucinations (χ2 = 8.55, P = 0.004), agitation (χ2 = 5.38, P = 0.026), depression (χ2 = 22.78, P < 0.001), anxiety (χ2 = 47.17, P < 0.001), aberrant motor behavior (χ2 = 4.72, P = 0.034), and sleep (χ2 = 4.16, P = 0.047) was higher in community-dwelling patients than that in institution-dwelling patients. Moreover, the frequency, severity, and disturbance of almost all of the BPSDs were higher in community-dwelling patients than those in institution-dwelling patients, except for euphoria. High Odds of having hallucination (OR 2.48, 95% CI 1.37-4.49), anxiety (OR 7.36, 95% CI 3.82-14.17), sleep disorder (OR 1.77, 95% CI 1.02-3.10) was observed in community-dwelling patients. Severe dementia was another risk factor for having hallucination (OR 5.48, 95% CI 2.25-13.38), anxiety (OR 2.73, 95% CI 1.22-6.12), sleep disorder (OR 2.61, 95% CI 1.21-5.64), apathy (OR 3.03, 95% CI 1.49-6.19), and irritability (OR 2.6, 95% CI 1.24-5.51). Community-dwelling and severe dementia were two main risk factors for higher NPI scores (adjusted R2 = 0.30), and higher disturbance of anxiety (adjusted R2 = 0.21), sleep disorders (adjusted R2 = 0.15), hallucination (adjusted R2 = 0.12) and irritability (adjusted R2 = 0.11).

The prevalence and disturbance of BPSDs were higher in community-dwelling patients with dementia than institution-dwelling patients. Community-dwelling and severe dementia were two main risk factors for higher prevalence and disturbance of BPSDs, especially for anxiety, sleep disorders, and hallucination. Providing community-based BPSDs coping skill training and support for informal caregivers are needed.

Certain neuropsychiatric symptoms (NPS), namely apathy, depression, and anxiety demonstrated great value in predicting dementia progression, representing eventually an opportunity window for timely diagnosis and treatment. However, sensitive and objective markers of these symptoms are still missing. Therefore, the present study aims to investigate the association between automatically extracted speech features and NPS in patients with mild neurocognitive disorders.

Speech of 141 patients aged 65 or older with neurocognitive disorder was recorded while performing two short narrative speech tasks. NPS were assessed by the neuropsychiatric inventory. Paralinguistic markers relating to prosodic, formant, source, and temporal qualities of speech were automatically extracted, correlated with NPS. Machine learning experiments were carried out to validate the diagnostic power of extracted markers.

Different speech variables are associated with specific NPS; apathy correlates with temporal aspects, and anxiety with voice quality—and this was mostly consistent between male and female after correction for cognitive impairment. Machine learning regressors are able to extract information from speech features and perform above baseline in predicting anxiety, apathy, and depression scores.

Different NPS seem to be characterized by distinct speech features, which are easily extractable automatically from short vocal tasks. These findings support the use of speech analysis for detecting subtypes of NPS in patients with cognitive impairment. This could have great implications for the design of future clinical trials as this cost-effective method could allow more continuous and even remote monitoring of symptoms.