Neuropsychiatric symptoms in vascular cognitive impairment: A comparative study between CADASIL and sporadic small...

Neuropsychiatric symptoms (NPS) are common in cerebral small vessel disease (SVD), but their patterns across genetic and sporadic forms remain incompletely characterized. We compared NPS prevalence, correlates, and caregiver distress in vascular cognitive impairment (VCI) due to cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) and sporadic SVD.

Patients with VCI due to CADASIL or sporadic SVD were recruited from the Taiwan-Associated Genetic and Non-genetic Small Vessel Disease cohort. NPS were assessed using the Neuropsychiatric Inventory. Clinically significant NPS were defined as a frequency multiplied by severity score of 2 or higher. Group differences were examined using logistic regression adjusted for age and sex. Clinical and imaging correlates were analyzed separately for each group, and caregiver distress was evaluated using linear regression.

Among 245 VCI patients (100 CADASIL, 145 sporadic SVD), clinically significant NPS were frequent (72% vs. 63%, p = 0.133). Affective subsyndromes were more common in CADASIL (42% vs. 26%, p = 0.040). In CADASIL, dyslipidemia was associated with higher odds of NPS (adjusted OR = 4.63, p = 0.005), whereas anterior temporal involvement was associated with lower odds (adjusted OR = 0.29, p = 0.020). In sporadic SVD, dementia severity was the strongest correlate of NPS. Psychotic and apathy subsyndromes increased with dementia severity in both groups, whereas affective subsyndromes did not. Caregiver distress correlated strongly with symptom severity (Spearman's ρ = 0.42-0.70).

NPS are highly prevalent in VCI due to CADASIL and sporadic SVD, with affective symptoms particularly prominent in CADASIL.