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Mild Behavioral Impairment as a Marker of Cognitive Decline in Cognitively Normal Older Adults

Byron Creese1, Helen Brooker1, Zahinoor Ismail2

  • 1University of Exeter Medical School (BC, HB, KAW, AC, CB), University of Exeter, Exeter, UK.

The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry
|March 24, 2019
PubMed
Abstract

Insights

Mild behavioral impairment (MBI) is linked to faster declines in attention and working memory in cognitively normal older adults. This suggests MBI may be an early indicator of neurodegenerative disease, potentially before mild cognitive impairment (MCI).

Area of Science:

  • Neuroscience
  • Gerontology
  • Cognitive Psychology

Background:

  • Mild behavioral impairment (MBI) is a syndrome of later-life neuropsychiatric symptoms (NPS).
  • MBI is considered an at-risk state for cognitive decline and dementia in individuals with mild cognitive impairment (MCI).
  • The association between MBI and cognitive changes in cognitively normal individuals remains under investigation.

Purpose of the Study:

  • To investigate the relationship between MBI and progressive neuropsychological performance changes.
  • To determine if MBI predicts cognitive decline in individuals without MCI.
  • To explore MBI as a potential early marker for neurodegenerative diseases.

Main Methods:

  • A cohort of 9,931 cognitively normal older adults from the PROTECT study was analyzed.
  • Participants completed a comprehensive neuropsychological battery assessing attention, reasoning, executive function, and working memory at baseline and 1-year follow-up.
  • Mild behavioral impairment (MBI) was assessed using the Mild Behavioral Impairment Checklist, categorizing participants into No Symptoms, Intermediate NPS, and MBI groups. Data were analyzed using mixed-effects models.

Main Results:

  • 10% of participants (949 individuals) were identified as having MBI.
  • Individuals with MBI exhibited significantly worse baseline cognitive performance compared to those without MBI.
  • MBI was associated with a significantly greater decline over 1 year in measures of attentional intensity, sustained attention, attentional fluctuation, and working memory.

Conclusions:

  • Mild behavioral impairment (MBI) is associated with accelerated decline in attention and working memory among cognitively normal older adults.
  • MBI may serve as an earlier biomarker for neurodegenerative disease than MCI, potentially detectable during subjective cognitive decline.
  • MBI presents a potential novel target for dementia prevention strategies and clinical trials.
Keywords:
CogTrackMBIMBI-CPROTECTpreclinical dementiasubjective cognitive decline (SCD)

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