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Clinical Manifestations.

Mark A Dubbelman1,2,3, Grace Ma2, Rebecca E Amariglio1,2,4

  • 1Harvard Medical School, Boston, MA, USA.

Alzheimer'S & Dementia : the Journal of the Alzheimer'S Association
|December 24, 2025
PubMed
Summary
This summary is machine-generated.

Neuropsychiatric symptoms (NPS) in older adults are linked to poorer daily functioning, even before cognitive decline is apparent. Addressing these symptoms may improve quality of life and daily performance.

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Area of Science:

  • Geriatric Psychiatry
  • Neurodegenerative Diseases
  • Cognitive Aging

Background:

  • Neuropsychiatric symptoms (NPS) can precede cognitive decline in older adults, potentially indicating underlying neurodegeneration.
  • Instrumental activities of daily living (IADLs) changes are early signs of cognitive impairment, influenced by NPS.
  • This study focuses on NPS and daily functioning in cognitively unimpaired older adults.

Purpose of the Study:

  • To examine the association between self- and study-partner-reported NPS and daily functioning in cognitively unimpaired older adults.
  • To investigate the link between affective symptoms (depression, anxiety) and daily functioning.
  • To test the hypothesis that increased NPS correlates with worse daily functioning.

Main Methods:

  • 177 cognitively unimpaired older adults and their study-partners participated.
  • Assessments included NPS (MBI-C, AES, GDS, GAI, SHAPS) and daily functioning (ADCS ADL-PI).
  • Linear regression models analyzed cross-sectional relationships, adjusted for age, sex, and education.

Main Results:

  • Self-reported NPS (MBI-C, GDS, GAI) and both self/study-partner-reported Apathy Evaluation Scale (AES) linked to poorer self-reported daily functioning (ADCS ADL-PI).
  • Study-partner-reported daily functioning (ADCS ADL-PI) correlated with SHAPS, MBI-C, AES, GDS, and GAI.
  • Worse instrumental activities of daily living (IADL) performance was associated with increased neuropsychiatric symptoms.

Conclusions:

  • Greater NPS and affective symptoms (depression, anxiety, anhedonia, apathy) correlate with worse daily functioning in cognitively unimpaired older adults.
  • Recognizing and treating NPS is crucial for improving daily functioning and quality of life before overt cognitive impairment.
  • Consider symptom source and IADL measurement methods when using them as clinical trial outcomes.