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. 2023 Jul 20:14:1194917.
doi: 10.3389/fneur.2023.1194917. eCollection 2023.

Cognitive impairments predict the behavioral and psychological symptoms of dementia

Solaphat Hemrungrojn  1   2 , Sookjaroen Tangwongchai  1   3 , Thammanard Charernboon  4 , Muthita Phanasathit  5 , Pisit Chaipresertsud  6 , Pacharaporn Maleevach  7 , Yuttachai Likitjaroen  8 , Kammant Phanthumchinda  8 , Ratiya Assawatinna  2 , Arisara Amrapala  1   2 , Michael Maes  1   2   3   9   10   10   11
Affiliations

Cognitive impairments predict the behavioral and psychological symptoms of dementia

Solaphat Hemrungrojn et al. Front Neurol. .

Abstract

Introduction: The purpose of this study was to (1) validate the Thai version of the Neuropsychiatric Inventory Questionnaire (NPI-Q) as a screening tool for behavioral and psychological symptoms of dementia (BPSD), and (2) examine the relationship between cognitive performance and BPSD in an elderly population with amnestic mild cognitive impairment (aMCI) and dementia of Alzheimer's type (DAT).

Methods: One hundred and twenty participants, comprising 80 aMCI and 40 DAT patients, and their respective caregivers were included in the study. Participants completed the NPI-Q and the Neuropsychiatric Inventory (NPI) within 2 weeks of each other and cognitive performance was primarily assessed using the Montreal Cognitive Assessment (MoCA).

Results: The Thai NPI-Q had good validity and reliability. Pure exploratory bifactor analysis revealed that a general factor and a single-group factor (with high loadings on delusions, hallucinations, apathy, and appetite) underpinned the NPI-Q domains. Significant negative correlations between the MoCA total score and the general and single-group NPI-Q scores were found in all subjects (aMCI + DAT combined) and DAT alone, but not in aMCI. Cluster analysis allocated subjects with BPSD (10% of aMCI and 50% of DAT participants) into a distinct "DAT + BPSD" class.

Conclusion: The NPI-Q is an appropriate instrument for assessing BPSD and the total score is largely predicted by cognitive deficits. It is plausible that aMCI subjects with severe NPI-Q symptoms (10% of our sample) may have a poorer prognosis and constitute a subgroup of aMCI patients who will likely convert into probable dementia.

Keywords: Alzheimer’s disease; behavioral dysfunction; cognitive dysfunction; memory; neuropsychiatric symptoms; psychiatry.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Partial least square path model. This model shows that the neurocognitive scores (conceptualized as a latent vector) predict both the general Neuropsychiatric Inventory Questionnaire (NPI-Q) factor score and the single group NPI-Q factor score. The latter was conceptualized as a factor extracted from four NPI-Q subdomains. Age and education predicted part of the variance in the neurocognitive factor score. Shown are the path coefficients (all p < 0.001, except age: p = 0.008) and the loadings on the outer models (all p < 0.001). The figures within the blue circles indicate explained variance. GF, general factor; SGF, single-group factor; NPIQ, Neuropsychiatric Inventory Questionnaire; apat, apathy; app, appetite; hall, hallucinations; del, delusions; TMSE, Thai Mini-Mental State Examination; MoCA, Montreal Cognitive Assessment; or, orientation; nam, naming; lan, language; del, delayed recall; att, attention; abs, abstract thinking; exe, executive functions.
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