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Published on: January 11, 2020
Mild Behavioral Impairment is Associated With Incident Cognitive Decline Among Dementia-Free, Racially Diverse Older
Barbara L Fischer1, Carol A Van Hulle1, Derek L Norton1
1Department of Neurology (BLF), University of Wisconsin-Madison, Madison, WI; Geriatric Research Education and Clinical Center (GRECC) Wm. S. Middleton VA Hospital (BLF, SB, CEG), Madison, WI; Wisconsin Alzheimer's Institute (CAVH, NHL, CEG), University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI; Wisconsin Alzheimer's Disease Research Center (CAVH, DLN, SB, DCG, CEG), University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI; Division of Geriatrics and Gerontology (CAVH, DLN, MFW, GE, SB, DCG, CEG), Department of Medicine, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI; Department of Biostatistics and Medical Informatics (DLN), University of Wisconsin-Madison, Madison, WI; and the Department of Psychology (DCG), University of Wisconsin-Madison, Madison, WI.
Objectives:
To determine whether MBI associates with worse cognitive performance over time and with incident cognitive decline in an older, racially/ethnically diverse cohort at early stages of cognitive change.
Design:
This observational cohort study followed participants from the Wisconsin Alzheimer's Disease Research Center Clinical Core (WADRC) for up to 13 visits.
Setting:
An urban university research center.
Participants:
Participants from the WADRC Clinical Core were included in this convenience sample if they were without dementia, had undergone at least 1 cognitive assessment, and completed measures of cognitive, clinical and affective function.
Measurements:
MBI was assessed using the Neuropsychiatric Inventory. Linear mixed effects models (LME) were fit to cognitive outcomes Trailmaking Tests A and B (TMT-A, B) and Wechsler Logical Memory (LM). Cox proportional hazard models assessed whether MBI was related to risk for incident global Clinical Dementia Rating Scale (CDR >0).
Results:
N = 584 participants with mean age 64.6 years, range 46-92.6 years, 59.4% female and 17% African American. LME results indicated participants with MBI exhibited worse age-associated decline on TMT-B, compared to those without MBI (beta=0.008, p = 0.01, CI: 0.002, 0.01, t(337) = 2.4, p = 0.01). MBI at baseline was associated with a significant hazard ratio (HR) indicating an increased risk of decline on the CDR (HR: 2.84; HR 95% CI: 1.68 - 4.81; p = 0.0001).
Conclusions:
MBI associated with worse cognitive performance and incident cognitive decline in a racially diverse, older adult sample at early stages of cognitive change. Increased awareness of the late life emergence of neuropsychiatric symptoms is warranted to assist in identification and improve prognostication and treatment of neurodegenerative disease.
Insights
Mild behavioral impairment (MBI) is linked to faster cognitive decline and increased dementia risk in older adults. Early identification of these neuropsychiatric symptoms is crucial for better neurodegenerative disease management.
Area of Science:
- Neuroscience
- Gerontology
- Psychiatry
Background:
- Neuropsychiatric symptoms, including mild behavioral impairment (MBI), are common in aging.
- Understanding the association between MBI and cognitive trajectory is vital for early intervention in neurodegenerative diseases.
Purpose of the Study:
- To investigate the relationship between MBI and cognitive performance over time.
- To determine if MBI predicts incident cognitive decline in a diverse older adult cohort.
Main Methods:
- An observational cohort study followed 584 participants from the Wisconsin Alzheimer's Disease Research Center.
- Neuropsychiatric Inventory (MBI) and cognitive tests (Trailmaking Tests A and B, Wechsler Logical Memory) were administered.
- Linear mixed-effects models and Cox proportional hazard models analyzed cognitive changes and decline risk.
Main Results:
- Participants with MBI showed significantly worse age-associated decline in Trailmaking Test B performance.
- Baseline MBI was associated with a 2.84-fold increased risk of global cognitive decline (CDR >0).
Conclusions:
- MBI is associated with accelerated cognitive decline and increased risk of dementia in older, diverse populations.
- Recognizing late-life neuropsychiatric symptoms aids in the identification, prognostication, and treatment of neurodegenerative conditions.
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