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Association of neuropsychiatric symptoms and sub-syndromes with cognitive impairment in community-dwelling Asian elderly

Published online by Cambridge University Press:  23 July 2015

Xin Xu ,
Seow Li Ang ,
Saima Hilal ,
Qun Lin Chan ,
Tien Yin Wong ,
Narayanaswamy Venketasubramanian ,
Mohammad Kamran Ikram  and
Christopher Li-Hsian Chen
Xin Xu
Affiliation:
Memory Ageing and Cognition Centre (MACC), National University Health System, Singapore Department of Pharmacology, National University of Singapore, Singapore
Seow Li Ang
Affiliation:
Memory Ageing and Cognition Centre (MACC), National University Health System, Singapore Department of Pharmacology, National University of Singapore, Singapore
Saima Hilal
Affiliation:
Memory Ageing and Cognition Centre (MACC), National University Health System, Singapore Department of Pharmacology, National University of Singapore, Singapore Department of Ophthalmology, National University of Singapore, Singapore
Qun Lin Chan
Affiliation:
Memory Ageing and Cognition Centre (MACC), National University Health System, Singapore Department of Pharmacology, National University of Singapore, Singapore
Tien Yin Wong
Affiliation:
Singapore Eye Research Institute, Singapore National Eye Center, Singapore Academic Medicine Research Institute, Duke-NUS Graduate Medical School, Singapore
Narayanaswamy Venketasubramanian
Affiliation:
Raffles Neuroscience Centre, Raffles Hospital, Singapore
Mohammad Kamran Ikram
Affiliation:
Memory Ageing and Cognition Centre (MACC), National University Health System, Singapore Singapore Eye Research Institute, Singapore National Eye Center, Singapore Academic Medicine Research Institute, Duke-NUS Graduate Medical School, Singapore
Christopher Li-Hsian Chen*
Affiliation:
Memory Ageing and Cognition Centre (MACC), National University Health System, Singapore Department of Pharmacology, National University of Singapore, Singapore
*
Correspondence should be addressed to: Dr. Christopher Li-Hsian Chen, Department of Pharmacology, National University Health System, Clinical Research Centre, MD11, Level 5, #05-09, 10 Medical Drive, 117597, Singapore. Phone: +65 65155885; Fax: +65 68724101. Email: phccclh@nus.edu.sg.
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Abstract

Objectives:

To investigate the presence of neuropsychiatric symptoms (NPS) and sub-syndromes in elderly community-dwelling Asians with varying severity of cognitive impairment.

Methods:

Chinese and Malay participants (n = 613) from the Epidemiology of Dementia in Singapore (EDIS) Study aged ≥ 60 years underwent clinical examination, neuropsychological testing, and NPS assessment using the Neuropsychiatric Inventory (NPI). Diagnosis of no cognitive impairment (NCI), cognitive impairment-no dementia (CIND), including CIND-mild and CIND-moderate, and dementia were made using established criteria.

Results:

A significant increase in the numbers of NPS was observed accompanying with increasing severity of cognitive impairment (p < 0.001). Compared to those with NCI/CIND-mild, participants with CIND-moderate [Odds ratio (OR): 4.2, 95% confidence interval (CI): 1.8–10.0] or dementia [OR: 9.2, 95% CI: 2.3–36.0] were more likely to have two or more neuropsychiatric sub-syndromes. Participants with CIND-moderate were more likely to have hyperactivity [OR: 2.0, 95% CI: 1.0–3.8] and apathy [OR: 2.9, 95% CI: 1.0–8.4] sub-syndromes, whereas patients with dementia were more likely to have psychosis [OR: 6.9, 95% CI: 2.4–20.1], affective (OR: 8.7, 95% CI: 1.8–42.9), and hyperactivity (OR: 5.4, 95% CI: 1.8–16.1). Furthermore, executive dysfunction and visual memory impairment were associated with the presence of three neuropsychiatric sub-syndromes; whist language and visuomotor speed impairment were related to the presence of two sub-syndromes. By contrast, impairment in attention, verbal memory, and visuoconstruction were not associated with any of the sub-syndromes.

Conclusions:

The presence of NPS and sub-syndromes increase with increasing severities of cognitive impairment, and different neuropsychiatric syndromes are associated with specific impairment on cognitive domains in community-dwelling Asian elderly.

Keywords

neuropsychiatric symptomssub-syndromescommunity dwellingAsian
Type
Research Article
Information
International Psychogeriatrics , Volume 27 , Issue 11 , November 2015 , pp. 1839 - 1847
Copyright
Copyright © International Psychogeriatric Association 2015 

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References

Aalten, P. et al. (2007). Neuropsychiatric syndromes in dementia. results from the European Alzheimer Disease Consortium: Part I. Dementia and Geriatric Cognitive Disorders, 24, 457–463. doi: 10.1159/000110738.Google Scholar
Aalten, P. et al. (2008). Consistency of neuropsychiatric syndromes across dementias: results from the European Alzheimer Disease Consortium. Dementia and Geriatric Cognitive Disorders, 25, 1–8. doi: 10.1159/000111082.Google Scholar
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Washington, DC: American Psychiatric Association.Google Scholar
Beaudreau, S. A, Fairchild, J. K., Spira, A. P., Lazzeroni, L. C. and O’Hara, R. (2013). Neuropsychiatric symptoms, apolipoprotein E gene, and risk of progression to cognitive impairment, no dementia and dementia: the Aging, Demographics, and Memory Study(ADAMS). International Journal of Geriatric Psychiatry, 28, 672–680. doi: 10.1002/gps.3868.Google Scholar
Catindig, J. A., Venketasubramanian, N., Ikram, M. K. and Chen, C. (2012). Epidemiology of Dementia in Asia: insights on prevalence, trends and novel risk factors. Journal of the Neurological Sciences, 321, 11–16. doi: 10.1016/j.jns.2012.07.023.CrossRefGoogle ScholarPubMed
Chan, W. C. et al. (2010). Prevalence of neuropsychiatric symptoms in Chinese older persons with mild cognitive impairment - a population-based study. American Journal of Geriatric Psychiatry, 18, 948–954. doi: 10.1097/JGP.0b013e3181d69467.Google Scholar
Cheng, S. T., Kwok, T. and Lam, L. C. (2012). Neuropsychiatric symptom clusters of Alzheimer's disease in Hong Kong Chinese: prevalence and confirmatory factor analysis of the neuropsychiatric inventory. International Psychogeriatrics, 24, 1465–1473. doi: 10.1017/S1041610212000609.Google Scholar
Chong, M. S. et al. (2006). Screening for dementia in the older Chinese with a single question test on progressive forgetfulness. International Journal of Geriatric Psychiatry, 21, 442–448. doi: 10.1002/gps.1488.Google Scholar
Cummings, J. L. (1997). The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology, 48, S10–S16.Google Scholar
Feng, L., Yap, P. L. K., Lee, T. S. and Ng, T. P. (2009). Neuropsychiatric symptoms in mild cognitive impairment: a population-based study. Asia-Pacific Psychiatry, 1, 23–27.Google Scholar
Gauthier, S., Wirth, Y. and Mobius, H. J. (2005). Effects of memantine on behavioural symptoms in Alzheimer's disease patients: an analysis of the neuropsychiatric inventory (NPI) data of two randomised, controlled studies. International Journal of Geriatric Psychiatry, 20, 459–464. doi: 10.1002/gps.1341.Google Scholar
Geda, Y. E. et al. (2004). De novo genesis of neuropsychiatric symptoms in mild cognitive impairment (MCI). International Psychogeriatrics, 16, 51–60. doi: 10.1017/S1041610204000067.CrossRefGoogle ScholarPubMed
Geda, Y. E. et al. (2008). Prevalence of neuropsychiatric symptoms in mild cognitive impairment and normal cognitive aging: population-based study. Archives of General Psychiatry, 65, 1193–1198. doi: 10.1001/archpsyc.65.10.1193.Google Scholar
Haibo, X. et al. (2013). Prevalence and severity of behavioral and psychological symptoms of dementia (BPSD) in community dwelling Chinese: findings from the Shanghai three districts study. Aging and Mental Health, 17, 748–752. doi: 10.1080/13607863.2013.781116.Google Scholar
Hilal, S. et al. (2013). Prevalence of cognitive impairment in Chinese: epidemiology of dementia in Singapore study. Journal of Neurology, Neurosurgery & Psychiatry, 84, 686–692. doi: 10.1136/jnnp-2012-304080.Google Scholar
Hilal, S. et al. (2015). Intracranial stenosis, cerebrovascular diseases, and cognitive impairment in Chinese. Alzheimer Disease and Associated Disorders, 29, 12–17.Google Scholar
Ikeda, M. et al. (2004). Dementia associated mental and behavioural disturbances in elderly people in the community: findings from the first Nakayama study. Journal of Neurology, Neurosurgery & Psychiatry, 75, 146–148.Google Scholar
Johnson, M. D. and Ojemann, G. A. (2000). The role of the human thalamus in language and memory: evidence from electrophysiological studies. Brain and Cognition, 42, 218–230.Google Scholar
Kang, H. S., Ahn, I. S., Kim, J. H. and Kim, D. K. (2010). Neuropsychiatric symptoms in Korean patients with Alzheimer's disease: exploratory factor analysis and confirmatory factor analysis of the neuropsychiatric inventory. Dementia and Geriatric Cognitive Disorders, 29, 82–87. doi: 10.1159/000264629.Google Scholar
Lyketsos, C. G., Lopez, O., Jones, B., Fitzpatrick, A. L., Breitner, J. and DeKosky, S. (2002). Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the Cardiovascular Health Study. JAMA, 288, 1475–1483. doi:10.1001/jama.288.12.1475.Google Scholar
Lyketsos, C. G., Steinberg, M., Tschanz, J. T., Norton, M. C., Steffens, D. C. and Breitner, J. C. (2000). Mental and behavioral disturbances in dementia: findings from the cache county study on memory in aging. American Journal of Psychiatry, 157, 708–714. doi: 10.1176/appi.ajp.157.5.708.Google Scholar
Marchand, W. R., Bennett, P. J. and Dilda, V. (2005). Evidence for frontal-subcortical circuit abnormalities in bipolar affective disorder. Psychiatry, 2, 26–33.Google Scholar
Muangpaisan, W., Intalapaporn, S. and Assantachai, P. (2008). Neuropsychiatric symptoms in the community-based patients with mild cognitive impairment and the influence of demographic factors. International Journal of Geriatric Psychiatry, 23, 699–703. doi: 10.1002/gps.1963.Google Scholar
Narasimhalu, K. et al. (2009). Severity of CIND and MCI predict incidence of dementia in an ischemic stroke cohort. Neurology, 73, 1866–1872. doi: 10.1212/WNL.0b013e3181c3fcb7.Google Scholar
Okura, T., Plassman, B. L., Steffens, D. C., Llewellyn, D. J., Potter, G. G. and Langa, K. M. (2010). Prevalence of neuropsychiatric symptoms and their association with functional limitations in older adults in the United States: the aging, demographics, and memory study. Journal of the American Geriatrics Society, 58, 330–337. doi: 10.1111/j.1532-5415.2009.02680.x.Google Scholar
Paulsen, J. S. et al. (2000). Incidence of and risk factors for hallucinations and delusions in patients with probable AD. Neurology, 54, 1965–1971.Google Scholar
Peters, M. E. et al. (2012) Prevalence of neuropsychiatric symptoms in CIND and its subtypes: the cache county study. American Journal of Geriatric Psychiatry, 20, 416–424. doi: 10.1097/JGP.0b013e318211057d.Google Scholar
Peters, M. E. et al. (2013). Neuropsychiatric symptoms as risk factors for progression from CIND to dementia: the Cache County Study. American Journal of Geriatric Psychiatry, 21, 1116–1124. doi: 10.1016/j.jagp.2013.01.049.Google Scholar
Rosman, M. et al. (2012). Singapore malay eye study: rationale and methodology of 6-year follow-up study (SiMES-2). Clinical & Experimental Ophthalmology, 40, 557–568. doi: 10.1111/j.1442-9071.2012.02763.x.Google Scholar
Sahadevan, S., Lim, P. P., Tan, N. J. and Chan, S. P. (2000). Diagnostic performance of two mental status tests in older Chinese: influence of education and age on cut-off values. International Journal of Geriatric Psychiatry, 15, 234–241. doi: 10.1002/(SICI)1099-1166(200003).Google Scholar
Selbæk, G. and Engedal, K. (2012). Stability of the factor structure of the Neuropsychiatric Inventory in a 31-month follow-up study of a large sample of nursing-home patients with dementia. International Psychogeriatrics, 24, 62–73. doi: 10.1017/S104161021100086X.Google Scholar
Shinosaki, K., Nishikawa, T. and Takeda, M. (2000). Neurobiological basis of behavioral and psychological symptoms in dementia of the Alzheimer type. Psychiatry and Clinical Neurosciences, 54, 611–620. doi: 10.1046/j.1440-1819.2000.00773.x.Google Scholar
Steele, C., Rovner, B., Chase, G.A. and Folstein, M. (1990). Psychiatric symptoms and nursing home placement of patients with Alzheimer's disease. American Journal of Psychiatry, 147, 1049–1051.Google Scholar
Steinberg, M. et al. (2006). Risk factors for neuropsychiatric symptoms in dementia: the cache county study. International Journal of Geriatric Psychiatry, 21, 824–883. doi: 10.1002/gps.1567.Google Scholar
Tatsch, M. F. et al. (2006). Neuropsychiatric symptoms in Alzheimer disease and cognitively impaired, nondemented elderly from a community based sample in Brazil: prevalence and relationship with dementia severity. American Journal of Geriatric Psychiatry, 14, 438–445. doi:10.1097/01.JGP.0000218218.47279.db.Google Scholar
Wu, H. Z., Low, L. F., Xiao, S. and Brodaty, H. (2009). A pilot study of differences in behavioral and psychological symptoms of dementia in nursing home residents in Sydney and Shanghai. International Psychogeriatrics, 21, 476–484. doi: 10.1017/S1041610209008643.CrossRefGoogle ScholarPubMed