Mild behavioral impairment as a potential marker of predementia risk states in motor neuron diseases

Abstract

Background and purpose: Mild behavioral impairment (MBI) has been increasingly regarded as the neurobehavioral axis of predementia risk states, but a specific investigation of its detection as a potential marker of prodromal dementia in motor neuron diseases (MNDs) is still lacking. The aims of our study were therefore to explore MBI in MNDs both at onset and over the disease course, and to evaluate its relationship with baseline and longitudinal cognitive features.

Methods: Sixty MND patients with cognitive/behavioral, mood, and motor examinations were recruited and followed longitudinally for up to 15 months. Associations between baseline MBI symptoms and clinical features were tested using the Spearman correlation coefficient. Based on longitudinal data, relative deltas of variation for each cognitive measure were generated, and linear regression models were then used to evaluate the role of baseline MBI symptoms in predicting longitudinal rates of cognitive decline.

Results: At disease onset, the most impaired MBI domain was affective/emotional dysregulation, followed by impulse dyscontrol, apathy, and social inappropriateness. Greater MBI symptoms correlated with more severe baseline motor, cognitive/behavioral, and mood disturbances (p values from <0.001 to 0.05). Longitudinally, the greatest decline was observed in the affective/emotional dysregulation domain, followed by impulse dyscontrol, apathy, and social inappropriateness. Greater MBI symptoms at onset were significant predictors of more severe longitudinal cognitive decline in both amyotrophic lateral sclerosis (ALS)-specific and ALS-nonspecific functions (p values from <0.001 to 0.03).

Conclusions: MBI represents a valuable clinical marker of incident cognitive decline in MNDs, and its evaluation has good potential for detecting dementia in its preclinical/prodromal phase.

Keywords: amyotrophic lateral sclerosis; longitudinal cognitive decline; mild behavioral impairment; motor neuron diseases; prodromal dementia.

FIGURE 1

Boxplots showing baseline median and mean values (black dots) of Mild Behavioral Impairment Checklist domain scores in the whole motor neuron disease sample

FIGURE 2

Spaghetti plots showing individual Mild Behavioral Impairment Checklist domain scores across longitudinal examinations. MBI, mild behavioral impairment

FIGURE 3

Boxplots showing baseline median and mean values (black dots) of Mild Behavioral Impairment Checklist domain deltas of variation in the whole motor neuron disease sample