Hostname: page-component-cd4964975-598jt Total loading time: 0 Render date: 2023-03-28T16:44:31.271Z Has data issue: true Feature Flags: { "useRatesEcommerce": false } hasContentIssue true

Mild behavioral impairment as a predictor of cognitive functioning in older adults

Published online by Cambridge University Press:  27 May 2020

Hillary J. Rouse*
School of Aging Studies, University of South Florida, Tampa, FL, USA
Brent J. Small
School of Aging Studies, University of South Florida, Tampa, FL, USA
John A. Schinka
School of Aging Studies, University of South Florida, Tampa, FL, USA
David A. Loewenstein
Wien Center for Alzheimer’s Disease and Memory Disorders, Mount Sinai Medical Center, University of Miami, Miami, FL, USA
Ranjan Duara
Wien Center for Alzheimer’s Disease and Memory Disorders, Mount Sinai Medical Center, University of Miami, Miami, FL, USA
Huntington Potter
Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
Correspondence should be addressed to: Hillary Rouse, University of South Florida, College of Behavioral and Community Sciences, School of Aging Studies, 4202 E Fowler Ave, Tampa, FL33620, USA. Email:



To assess the influence of mild behavioral impairment (MBI) on the cognitive performance of older adults who are cognitively healthy or have mild cognitive impairment (MCI).


Secondary data analysis of a sample (n = 497) of older adults from the Florida Alzheimer’s Disease Research Center who were either cognitively healthy (n = 285) or diagnosed with MCI (n = 212). Over half of the sample (n = 255) met the operationalized diagnostic criteria for MBI. Cognitive domains of executive function, attention, short-term memory, and episodic memory were assessed using a battery of neuropsychological tests.


Older adults with MBI performed worse on tasks of executive function, attention, and episodic memory compared to those without MBI. A significant interaction revealed that persons with MBI and MCI performed worse on tasks of episodic memory compared to individuals with only MCI, but no significant differences were found in performance in cognitively healthy older adults with or without MBI on this cognitive domain. As expected, cognitively healthy older adults performed better than individuals with MCI on every domain of cognition.


The present study found evidence that independent of cognitive status, individuals with MBI performed worse on tests of executive function, attention, and episodic memory than individuals without MBI. Additionally, those with MCI and MBI perform significantly worse on episodic memory tasks than individuals with only MCI. These results provide support for a unique cognitive phenotype associated with MBI and highlight the necessity for assessing both cognitive and behavioral symptoms.

Original Research Article
© International Psychogeriatric Association 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Beekly, D. et al. (2007). The National Alzheimer’s Coordinating Center (NACC) Database: the Uniform Data Set. Alzheimer’s Disease and Associated Disorders, 21, 249258. ScholarPubMed
Benton, A.H. (1967). Problems of test construction in the field of aphasia. Cortex, 3, 3258. Scholar
Brandt, J. and Benedict, R. (1991). Hopkins Verbal Learning Test-Revised. Professional Manual. Florida: Psychological Assessment Resources.Google Scholar
Brodaty, H. et al. (2012). Neuropsychiatric symptoms in older people with and without cognitive impairment. Journal of Alzheimer’s Disease, 31, 411420. ScholarPubMed
Burhanullah, M. et al. (2020). Neuropsychiatric symptoms as risk factors for cognitive decline in clinically normal older adults: the Cache County Study. The American Journal of Geriatric Psychiatry, 28, 6471. ScholarPubMed
Cohen, J. (1973). Eta-squared and partial eta-squared in fixed factor ANOVA designs. Educational and Psychological Measurement, 33, 107112.CrossRefGoogle Scholar
Creese, B. et al. (2019). Mild behavioral impairment as a marker of cognitive decline in cognitively normal older adults. The American Journal of Geriatric Psychiatry, 27, 823834. ScholarPubMed
Cummings, J. (1997). The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology, 48, S10S16. ScholarPubMed
Duara, R. et al. (2010). Reliability and validity of an algorithm for the diagnosis of normal cognition, mild cognitive impairment, and dementia: implications for multicenter research studies. The American Journal of Geriatric Psychiatry, 18, 363370. Scholar
Duara, R. et al. (2008). Medial temporal lobe atrophy on MRI scans and the diagnosis of Alzheimer disease. Neurology, 71, 19861992. Scholar
Enders, C. (2010). Applied Missing Data Analysis. New York: The Guilford Press.Google Scholar
Geda, Y. et al. (2014). Baseline neuropsychiatric symptoms and the risk of incident mild cognitive impairment: a population-based study. American Journal of Psychiatry, 171, 572581. ScholarPubMed
Goldman, J., Williams-Gray, C., Barker, R., Duda, J. and Galvin, J. (2014). The spectrum of cognitive impairment in Lewy body diseases. Movement Disorders, 29, 608621. ScholarPubMed
Jessen, F. et al. (2014). A conceptual framework for research on subjective cognitive decline in preclinical Alzheimer’s disease. Alzheimer’s & Dementia, 10, 844852. ScholarPubMed
Johns, E. et al. (2009). Executive functions in frontotemporal dementia and Lewy body dementia. Neuropsychology, 23, 765777. ScholarPubMed
Ismail, Z. et al. (2017). The mild behavioral impairment checklist (MBI-C): a rating scale for neuropsychiatric symptoms in pre-dementia populations. Journal of Alzheimer’s Disease, 56, 929938. ScholarPubMed
Ismail, Z. et al. (2016). Neuropsychiatric symptoms as early manifestations of emergent dementia: provisional diagnostic criteria for mild behavioral impairment. Alzheimer’s & Dementia, 12, 195202. ScholarPubMed
Ivnik, R., Malec, J, Smith, G., Tangalos, E. and Petersen, R. (1996). Neuropsychological tests’ norms above age 55: COWAT, BNT, MAE token, WRAT-R reading, AMNART, STROOP, TMT, and JLO. The Clinical Neuropsychologist, 10, 262278. Scholar
Lo, T. et al. (2019). Association between neuropsychiatric symptom trajectory and conversion to Alzheimer’s disease. Alzheimer’s Disease & Associated Disorders, 17. Scholar
Lucas, J., Ivnik, R., Bohac, D., Tangalos, E., Graff-Radford, N. and Petersen, R. (1998). Mayo’s older Americans normative studies: category fluency norms. Journal of Clinical and Experimental Neuropsychology, 20, 194200. ScholarPubMed
Matsuoka, T., Ismail, Z. and Narumoto, J. (2019). Prevalence of mild behavioral impairment and risk of dementia in a psychiatric outpatient clinic. Journal of Alzheimer’s Disease, 70, 505513. Scholar
Matthews, K. et al. (2019). Racial and ethnic estimates of Alzheimer’s disease and related dementias in the United States (2015-2060) in adults aged ≥65 years. Alzheimer’s & Dementia, 15, 1724. Scholar
Morris, J. et al. (2006). The Uniform Data Set (UDS): clinical and cognitive variables and descriptive data from Alzheimer Disease Centers. Alzheimer Disease & Associated Disorders, 20, 210216. ScholarPubMed
Mortby, M., Burns, R., Eramudugolla, R., Ismail, Z. and Anstey, K. (2017). Neuropsychiatric symptoms and cognitive impairment: understanding the importance of co-morbid symptoms. Journal of Alzheimer’s Disease, 59, 141153. ScholarPubMed
Mortby, M.E., Ismail, Z. and Anstey, K.J. (2018). Prevalence estimates of mild behavioral impairment in a population-based sample of pre-dementia states and cognitively healthy older adults. International Psychogeriatrics, 30, 221232. Scholar
Okura, T., Plassman, B., Steffens, D., Llewellyn, D., Potter, G. and Langa, K. (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, 330337. ScholarPubMed
Peters, M. et al. (2013). Neuropsychiatric symptoms as risk factors for progression from CIND to dementia: the Cache County Study. The American Journal of Geriatric Psychiatry, 21, 11161124. ScholarPubMed
Petersen, R.C., Smith, G.E., Waring, S.C., Ivnik, R.J., Tangalos, E.G. and Kokmen, E. (1999). Mild cognitive impairment. Archives of Neurology, 56, 303308. ScholarPubMed
Reitan, R. (1958). Validity of the trail-making test as an indicator of organic brain damage. Perceptual and Motor Skills, 8, 271276. Scholar
Rosenberg, P., Mielke, M., Appleby, B., Oh, E., Leoutsakos, J. and Lyketsos, C. (2011). Neuropsychiatric symptoms in MCI subtypes: the importance of executive dysfunction. International Journal of Geriatric Psychiatry, 26, 364372. ScholarPubMed
Rosenberg, P., Mielke, M., Appleby, B., Oh, E., Geda, Y. and Lyketsos, C. (2013). The association of neuropsychiatric symptoms in MCI with incident dementia and Alzheimer disease. The American Journal of Geriatric Psychiatry, 21, 685695. ScholarPubMed
Schinka, J. et al. (2010). Defining mild cognitive impairment: impact of varying decision criteria on neuropsychological diagnostic frequencies and correlates. American Journal of Geriatric Psychiatry, 18, 684691. ScholarPubMed
Stroop, J.R. (1935). Studies of interference in serial verbal reactions. Journal of Experimental Psychology, 18, 643662. Scholar
Sheikh, F. et al. (2017). Prevalence of mild behavioral impairment in mild cognitive impairment and subjective cognitive decline, and its association with caregiver burden. International Psychogeriatrics, 30, 233244. ScholarPubMed
Taragano, F. et al. (2018). Risk of conversion to dementia in a mild behavioral impairment group compared to a psychiatric group and to a mild cognitive impairment group. Journal of Alzheimer’s Disease, 62, 227238. Scholar
Taragano, F., Allegri, R. and Lyketsos, C. (2008). Mild behavioral impairment: a prodromal stage of dementia. Dementia & Neuropsychology, 2, 256260. ScholarPubMed
Tombaugh, T., Kozak, J. and Reese, L. (1999). Normative data stratified by age and education for two measures of verbal fluency: FAS and animal naming. Archives of Clinical Neuropsychology, 14, 167177. ScholarPubMed
Vespa, J., Armstrong, D. and Medina, L. (2018). Demographic Turning Points for the United States: Population Projections for 2020 to 2060, Current Population Reports (P25-1144). Washington, DC: U.S. Census Bureau. Retrieved from: Scholar
Wechsler, D. (1997). Wechsler Adult Intelligence Scale, 3rd edition. Revised. Texas: The Psychological Corporation.Google Scholar
Wise, E., Rosenberg, P., Lyketsos, C. and Leoutsakos, J. (2019). Time course of neuropsychiatric symptoms and cognitive diagnosis in National Alzheimer’s Coordinating Centers volunteers. Alzheimer’s and Dementia: Diagnosis, Assessment and Disease Monitoring, 11, 333339. ScholarPubMed
Wittenberg, D., Possin, K., Rascovksy, K., Rankin, K., Miller, B. and Kramer, J. (2008). The early neuropsychological and behavioral characteristics of frontotemporal dementia. Neuropsychology Review, 18, 91102. ScholarPubMed