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Beyond the “C” in MCI: Noncognitive Symptoms in Amnestic and Non-amnestic Mild Cognitive Impairment

Published online by Cambridge University Press:  07 November 2014

James M. Ellison ,
David G. Harper ,
Yossi Berlow  and
Lauren Zeranski
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Abstract

Introduction:

How frequent and how clinically important are mood and behavioral symptoms among older adults with mild cognitive impairment (MCI)? Although these noncognitive behavioral symptoms (NCBS) are not represented in the diagnostic criteria for MCI, their clinical significance is increasingly recognized.

Methods:

To address this question, the authors identified a cohort of consecutively evaluated patients from a psychiatric hospital's outpatient memory clinic. These patients' records contained both a clinical assessment and a standardized set of evaluations including the Mini-Mental State Exam, the Neuropsychiatric Inventory (NPI), and the Geriatric Depression Scale. Using a standardized chart-review approach, the presence of any NPI-screened symptom was identified and the frequencies of specific NPI-screened symptoms were calculated for the Memory Clinic MCI cohort and for amnestic and non-amnestic MCI subgroups.

Results:

A total of 116 patient records were reviewed. Thirty-eight patients with MCI were identified. Twenty-two of these met criteria for amnestic MCI by Mayo Clinic criteria while 16 met criteria for non-amnestic MCI. At least one NPI-screened mood or behavioral symptom was present in 86.8% of these MCI patients. Depression/dysphoria (63.3%), apathy (60.5%), anxiety (47.4%), irritability (44.7%), and nighttime behaviors (42.1%) were the most frequent. While depression/dysphoria was distributed similarly between amnestic and non-amnestic subgroups, apathy was significantly more frequently associated with the amnestic subtype of MCI, and nighttime behaviors were more frequently associated with the non-amnestic subtype.

Conclusion:

Although the presence of NCBS is not required for a diagnosis of MCI, these symptoms are frequently present and constitute an important source of morbidity. Apathy and depression may be difficult to differentiate, but targeted treatment of depression may fail to address apathy. Recognizing the limitations of this preliminary study, the authors suggest that apathy may be more characteristic of amnestic MCI while nighttime behaviors may be more characteristic of non-amnestic MCI.

Type
Original Research
Information
CNS Spectrums , Volume 13 , Issue 1 , January 2008 , pp. 66 - 72
Copyright
Copyright © Cambridge University Press 2008

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References

REFERENCES

1.Petersen, RC, Doody, RD, Kurz, A, et al.Current concepts in mild cognitive impairment. Arch Neurol. 2001;58:1985–1992.CrossRefGoogle ScholarPubMed
2.Winblad, B, Palmer, K, Kivipelto, M, et al.Mild cognitive impairment-beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Intern Med. 2004;156:240–246.Google Scholar
3.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed, text rev. Washington, DC: American Psychiatric Association, 2000.Google Scholar
4.Lyketsos, CG, Lopez, OL, Jones, B, Fitzpatrick, AL, Breitner, J, DeKosky, S. Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment. Results from the Cardiovascular Health Study. JAMA. 2002;288:1475–1483.Google Scholar
5.Folstein, MF, Folstein, SE, McHugh, PR. “Mini-Mental State.” A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–198.CrossRefGoogle ScholarPubMed
6.Dodson, CS, Johnson, MK. California Verbal Learning Test Manual. version 1. San Antonio, Tex: Psychological Corp; 1987.Google Scholar
7.Milberg, W. Geriatric Evaluation of Mental Status (GEMS). Jamaica Plain, Mass: Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System; 1982.Google Scholar
8.Reitan, R. The relation of the Trail Making Test to organic brain damage. J Consult Psychol. 1955;19:393–394.Google Scholar
9.Goodglass, H, Kaplan, E. Boston Diagnostic Aphasia Examination. Philadelphia, Penn: Lea & Febiger; 1983.Google Scholar
10.Meyers, JE, Meyers, KR. Rey Complex Figure Test and Recognition Trial: Professional Manual. Odessa, Tex: Psychological Association Resources, Inc.; 1995.Google Scholar
11.Cummings, JL, Mega, M, Gray, K, Rosenberg-Thompson, S, Carusi, DA, Gornbein, J. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology. 1994;44:2308–2314.Google Scholar
12.Sheikh, J, Yesavage, J. Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Clin Gerontol. 1986;5:165–173.Google Scholar
13.Lindman, H. Analysis of Variance in Complex Experimental Designs. San Francisco, Calif: W.H. Freeman & Co.; 1974.Google Scholar
14.Kruskal, W, Wallis, W. Use of ranks in one-criterion variance analysis. J Amer Statist Assn. 1952;47:583–621.CrossRefGoogle Scholar
15.Fisher, R. On the interpretation of X 2 from contingency tables, and the calculation of P. Journal of the Royal Statistical Society. 1922;85:87–94.CrossRefGoogle Scholar
16.Wilcoxon, F. Individual comparisons by ranking methods. Biometrics. 1945;1:80–83.CrossRefGoogle Scholar
17.Barnes, DE, Alexopoulos, GS, Lopez, OL, Williamson, JD, Yaffe, K. Depressive symptoms, vascular disease, and mild cognitive impairment. Arch Gen Psychiatry. 2006;63:273–280.Google Scholar
18.Berger, AK, Fratiglioni, L, Forsell, Y, Winblad, B, Bäckman, L. The occurrence of depressive symptoms in the preclinical phase of AD: a population-based study. Neurology. 1999;53:1998–2002.Google Scholar
19.Chan, DC, Kasper, JD, Black, BS, Rabins, PV. Prevalence and correlates of behavioral and psychiatric symptoms in community-dwelling elders with dementia or mild cognitive impairment: the Memory and Medical Care Study. Int J Geriatr Psychiatry. 2003;18:174–182.Google Scholar
20.Feldman, H, Scheltens, P, Scarpini, E, et al.Behavioral symptoms in mild cognitive impairment. Neurology. 2004;62:1199–1201.Google Scholar
21.Forsell, Y, Palmer, K, Fratiglioni, L. Psychiatric symptoms/syndromes in elderly persons with mild cognitive impairment. Data from a cross-sectional study. Acta Neurol Scand Suppl. 2003;179:25–28.Google Scholar
22.Gabryelewicz, T, Styczynska, M, Luczywek, E, et al.The rate of conversoin of mild cognitive impairment to dementia: predictive role of depression. Int J Geriatr Psychiatry. 2007;22:563–567.CrossRefGoogle ScholarPubMed
23.Ganguli, M, Du, Y, Dodge, HH, Ratcliff, GG, Chang, CC. Depressive symptoms and cognitive decline in late life. A prospective epidemiological study. Arch Gen Psychiatry. 2006;63:153–160.Google Scholar
24.Green, RC, Cupples, LA, Kurz, A, et al.Depression as a risk factor for Alzheimer Disease. The MIRAGE Study. Arch Neurol. 2003;60:753–759.CrossRefGoogle ScholarPubMed
25.Hogan, DB, Ebly, EM. Predicting who will develop dementia in a cohort of Canadian seniors. Can J Neurol Sci. 2000;27:18–24.CrossRefGoogle Scholar
26.Hwang, TJ, Masterman, DL, Ortiz, F, Fairbanks, LA, Cummings, JL. Mild cognitive impairment is associated with characteristic neuropsychiatric symptoms. Alzheimer Dis Assoc Disord. 2004;18:17–21.Google Scholar
27.Kumar, R, Jorm, AF, Parslow, RA, Sachdev, PS. Depression in mild cognitive impairment in a community sample of individuals 60–84 years old. Int Psychogeriatr. 2006;18:471–480.Google Scholar
28.Kuzis, G,Sabe, L, Tiberti, C, Dorrego, F, Stearkstein, S. Neuropsychological correlates of apathy and depression in patients with dementia. Neurology. 1999;52:1403–1407.Google Scholar
29.Li, Y-S, Meyer, JS, Thornby, J. Longitudinal follow-up of depressive symptoms among normal versus cognitively impaired elderly. Int J Geriatr Psychiatry. 2001;16:718–727.CrossRefGoogle ScholarPubMed
30.Modrego, P, Ferrandez, J. Depression in patients with mild cognitive impairment increases the risk of developing dementia of Alzheimer type. A prospective cohort study. Arch Neurol. 2004;61:1290–1293.CrossRefGoogle ScholarPubMed
31.Palmer, K, Berger, AK, Monastero, R, Winblad, B, Bäckman, L, Fratiglioni, L. Predictors of progression from mild cognitive impairment to Alzheimer disease. Neurology. 2007;68:1596–1602.Google Scholar
32.Peters, KR, Rockwood, K, Black, SE, et al.Characterizing neuropsychiatric symptoms in subjects referred to dementia clinics. Neurology. 2006;66:523–528.CrossRefGoogle ScholarPubMed
33.Potter, GG, Steffens, DC. Contribution of depression to cognitive impairment and dementia in older adults. Neurologist. 2007;13:105–117.Google Scholar
34.Ready, RE, Ott, BR, Grace, J, Cahn-Weiner, DA. Apathy and executive dysfunction in mild cognitive impairment and Alzheimer Disease. Am J Geriatr Psychiatry. 2003;11:222–228.Google Scholar
35.Robert, PH, Berr, C, Volteau, M, et al.Apathy in patients with mild cognitive impairment and the risk of developing dementia with Alzheimer's disease. A one-year follow-up study. Clin Neurol Neurosurg. 2006;108:733–736.Google Scholar
36.Rozzini, L, Chilovi, B, Trabucchi, M, Padovani, A. Depression is unrelated to conversion to dementia in patients with mild cognitive impairment [letter]. Arch Neurol. 2005;62:505.Google Scholar
37.Tatsch, MF, Bottino, CM, Azevedo, D, et al.Neuropsychiatric symptoms in Alzheimer disease and cognitively impaired, nondemented elderly from a community-based sample in Brazil: prevalence and relatoiunship with dementia severity. Am J Geriatr Psychiatry. 2006;14:438–445.Google Scholar
38.Teng, E, Lu, P, Cummings, J. Neuropsychiatric symptoms are associated with progression from Mild Cognitive Impairment to Alzheimer's Disease. Dement Geriatr Cogn Disord. 2007;24:253–259.Google Scholar
39.Geda, YE, Smith, GE, Knopman, DS, et al.De novo genesis of neuropsychiatric symptoms in Mild Cognitive Impairment (MCI). Int Psychogeriatr. 2004;16:51–60.Google Scholar
40.Solfrizzi, V, D'Introno, A, Colacicco, AM, et al.Incident occurrence of depressive symptoms among patients with mild cognitive impairment—The Italian Longitudinal Study on Aging. Dement Geriatr Cogn Disord. 2007;24:55–64.Google Scholar
41.Gallo, JJ, Rabins, PV, Lyketsos, CG, Tien, AY, Anthony, JC. Depression without sadness: functional outcomes of nondysphoric depression in later life. J Am Geriatr Soc. 1997;45:570–578.Google Scholar
42.Landes, AM, Sperry, SD, Strauss, ME, Geldmacher, DS. Apathy in Alzheimer's Disease. J Am Geriatr Soc. 2001;49:1700–1707.Google Scholar
43.Marshall, G, Monserratt, L, Harwood, D, Mandelkern, M, Cummings, J, Sultzer, D. Positron emission tomography (PET) metabolic correlates of apathy in Alzheimer's disease. Arch Neurol. 2007;64:1015–1020.Google Scholar
44.Wongpakaran, N, van Reekum, R, Wongpakaran, T, Clarke, D. Selective serotonin reuptake inhibitor use associates with apathy among depressed elderly: a casecontrol study. Ann Gen Psychiatry. 2007;6:7–12.Google Scholar