Neuropsychiatric Symptoms Among Hispanics: Results of the Maracaibo Aging Study

Abstract

Background: Neuropsychiatric symptoms play an important role in diagnosing and clinical follow-up of cognitive impairment and dementia.

Objective: We investigated the relationship between neuropsychiatric symptoms, cognitive impairment, and dementia in Hispanics.

Methods: We included 529 participants (age ≥40 years) from the Maracaibo Aging Study with standardized neuropsychiatric assessments, including the Neuropsychiatric Inventory (NPI). Based on the Clinical Dementia Rating and the Mini-Mental State Examination scores, participants' cognitive status was categorized into normal cognition, mild/moderate, and severe cognitive impairment. Diagnosis of dementia was established in a consensus conference. Statistical analyses included multivariable logistic regression models and area under the curve (AUC).

Results: The mean age of participants was 59.3 years, and 71.8%were women. The proportion of dementia was 6.8%. Disturbed sleep, anxiety, and depression were the most common neuropsychiatric symptoms in the study sample. In crude analyses, the proportions of hallucinations, aberrant motor behavior, agitation/aggression, apathy, delusions, irritability, eating disturbance, depression, and euphoria were differently distributed among cognitive status groups (p < 0.05). After accounting for confounders, aberrant motor behavior and agitation/aggression remained significantly associated with cognitive impairment and dementia (p < 0.05). The inclusion of the NPI domains significantly improved the AUC to discriminate severe cognitive impairment and dementia compared to a basic model that included sex, age, education, alcohol, obesity, serum glucose, total cholesterol, hypertension, and stroke.

Conclusion: Neuropsychiatric symptoms are associated with severe cognitive impairment and dementia. The addition of NPI items to the global cognitive assessment might help early detection of dementia in primary care settings.

Keywords: Aging; Alzheimer’s disease; Hispanics; cognitive impairment; dementia; neuropsychiatric inventory.

Fig. 1.

The proportion of neuropsychiatric symptoms in subjects with and without dementia at baseline. Neuropsychiatric Inventory (NPI). p-values are for the differences between groups.

Fig. 2.

Association between NPI domains and dementia. NPI, Neuropsychiatric Inventory; OR, odds ratios; CI, confidence interval. Models accounted for sex, age, education, alcohol habits, obesity, serum glucose levels, serum total cholesterol levels, previous stroke, and conventional hypertension. Statistics were not computed for disinhibition due to absence of symptoms for these categories.

Fig. 3.

Receiver Operating Characteristics Curve for Neuropsychiatric Inventory (NPI) to Discriminate Individuals with and without Mild-Cognitive (A), Severe Cognitive Impairment (B), and Dementia (C). AUC, area under the curve. Basic model accounted for sex, age, education, alcohol habits, obesity, serum glucose levels, serum total cholesterol levels, and conventional hypertension.