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Characterizing neuropsychiatric symptoms in subjects referred to dementia clinics

From the Department of Psychology (K.R.P., A.D.S.), Trent University, Peterborough, Ontario; Divisions of Geriatric Medicine and Neurology (K.R.), Department of Medicine, Dalhousie University, Halifax, Nova Scotia; Division of Neurology (S.E.B.), Department of Medicine, University of Toronto, Ontario; Division of Neurology (R.B.), Department of Medicine, Laval University, Quebec City, Quebec; Departments of Neurology and Neurosurgery, Psychiatry, and Medicine (S.G.), McGill University, Montreal, Quebec; Division of Geriatric Medicine (D.H.), Department of Medicine, University of Calgary, Ontario; Department of Clinical Neurological Sciences (A.K.), University of Western Ontario, London, Ontario; Division of Neurology (I.L.-E), Department of Medicine, University of Ottawa, Ontario; Divisions of Geriatric Medicine (B.L.B.) and Neurology (A.D.S., H.H.F.), Department of Medicine, and Department of Medical Genetics (A.D.S.), and University of British Columbia, Vancouver, Canada.

Address correspondence and reprint requests to Dr Feldman, Division of Neurology, University of British Columbia Hospital, S192-2211 Westbrook Mall, Vancouver, British Columbia, Canada V6T 2B5; e-mail: hfeldman{at}interchange.ubc.ca.

Objective: To characterize the neuropsychiatric symptoms (NPS) of subjects classified as not cognitively impaired (NCI), cognitively impaired–not demented (CIND), and dementia.

Methods: A Canadian Cohort Study of Cognitive Impairment and Related Dementias (ACCORD) is a longitudinal investigation of individuals referred to eight Canadian dementia centers for evaluation of cognitive impairment and neurobehavioral symptoms. Of the inception cohort of 804 subjects for whom the informant-based Neuropsychiatric Inventory (NPI) was completed at study entry, 35 were classified as NCI, 193 as CIND, and 576 as dementia. The three diagnostic groups were compared on each of the 12 NPI items. Within each diagnostic group, comparisons were also made between symptomatic (NPS+; total score > 1) and asymptomatic (NPS–; total score = 0) subjects on measures of general cognitive status and functional disability. A subset of the NCI and CIND individuals were also compared on a comprehensive neuropsychological test battery.

Results: There was at least one NPI item reported in 60% of subjects with NCI, 74% with CIND, and 89% with dementia. The item scores for delusions, hallucinations, agitation, apathy, disinhibition, aberrant motor behavior, and problems with appetite were greater in dementia subjects than in NCI or CIND. There were no significant differences between subjects with NCI and CIND on any NPI item. For each diagnostic group, NPS+ subjects were more impaired on functional but not neuropsychological measures.

Conclusions: Across all levels of cognition, neuropsychiatric symptoms (NPS) are an important feature in individuals referred to dementia clinics. The current data suggest that NPS may precede cognitive deficits in individuals classified as not cognitively impaired and cognitively impaired–not demented.

Supported by the Medical Research Council of Canada and the Pharmaceutical Manufactures Association of Canada, MRC PMAC program grant no. PA14197. Sponsorship from the PMAC was obtained from Sandoz, Smithkline Beecham, Pfizer Canada Inc., Hoffmann LaRoche Ltd., Janssen Pharmaceutical Inc., and Astra.

Disclosure: This research was funded through a peer-reviewed partnership grant (grant no. PA 14197) from the Medical Research Council of Canada and the Pharmaceutical Manufacturers Association of Canada (PMAC). The contributing members of the PMAC included Sandoz, Smith Kline Beecham, Pfizer, Hoffmann LaRoche, Janssen, Astra Zeneca, Hoechst Marion Roussel, and Bayer. These companies provided funding as a grant in aid and had no input into the design, conduct, collection, management, analysis, or interpretation of data, preparation, review, or approval of the manuscript.

Received June 8, 2005. Accepted in final form October 28, 2005.

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