Neuropsychiatric Symptoms as Predictor of Poor Clinical Outcome in Patients With Vascular Cognitive Impairment

Yoni C P Sep; Anna E Leeuwis; Lieza G Exalto; Jooske M Boomsma; Niels D Prins; Jurre H Verwer; Philip Scheltens; Wiesje M van der Flier; Geert Jan Biessels; TRACE-VCI study group

doi:10.1016/j.jagp.2021.12.014

Neuropsychiatric Symptoms as Predictor of Poor Clinical Outcome in Patients With Vascular Cognitive Impairment

Am J Geriatr Psychiatry. 2022 Jul;30(7):813-824. doi: 10.1016/j.jagp.2021.12.014. Epub 2022 Jan 2.

Authors

Yoni C P Sep¹, Anna E Leeuwis², Lieza G Exalto¹, Jooske M Boomsma¹, Niels D Prins³, Jurre H Verwer¹, Philip Scheltens³, Wiesje M van der Flier⁴, Geert Jan Biessels⁵; TRACE-VCI study group

Affiliations

¹ Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.
² Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands; Department of Old Age Psychiatry, GGZ inGeest, Amsterdam, the Netherlands.
³ Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.
⁴ Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands; Department of Epidemiology, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.
⁵ Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: G.J.Biessels@umcutrecht.nl.

PMID: 35082085
DOI: 10.1016/j.jagp.2021.12.014

Abstract

Objective: Examine the association between neuropsychiatric symptoms (NPS) and clinical outcome in memory clinic patients with vascular brain injury.

Design/setting: TRACE-VCI prospective memory clinic cohort with follow-up (2.1 ± 0.5 years).

Participants: Five hundred and seventy-five memory clinic patients with vascular brain injury on MRI (i.e. possible Vascular Cognitive Impairment [VCI]). Severity of cognitive impairment ranged from no objective cognitive impairment to mild cognitive impairment (MCI) and dementia.

Measurements: We used Neuropsychiatric Inventory (total score and score on hyperactive, psychotic, affective, and apathetic behavior domains) to measure NPS. We assessed the association between NPS and institutionalization, mortality and cognitive deterioration (increase ≥0.5 on Clinical Dementia Rating scale) with Cox proportional hazards models and logistic regression analyses.

Results: NPS were present in 89% of all patients, most commonly in the hyperactive and apathetic behavior domain. Across the whole cohort, affective behavior was associated with institutionalization (HR: 1.98 [1.01-3.87]), mainly driven by the dementia subgroup (HR: 2.06 [1.00-4.21]). Apathetic behavior was associated with mortality and cognitive deterioration (HR: 2.07 [1.10-3.90],OR: 1.67 [1.12-2.49], respectively), mainly driven by the MCI subgroup (HR: 4.93 [1.07-22.86],OR: 3.25 [1.46-7.24], respectively). Conversely, hyperactive behavior was related to lower mortality (HR: 0.54 [0.29-0.98]), again particularly driven by the MCI subgroup (HR:0.17 [0.04-0.75]). Psychotic behavior was associated with cognitive deterioration in patients with no objective cognitive impairment (OR: 3.10 [1.09-8.80]) and with institutionalization in MCI (HR: 12.45 [1.28-121.14]).

Conclusion: NPS are common and have prognostic value in memory clinic patients with possible VCI. This prognostic value depends on the severity of cognitive impairment.

Keywords: Neuropsychiatric symptoms; cognitive deterioration; institutionalization; mortality; vascular cognitive impairment.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Apathy*
Cerebrovascular Trauma* / complications
Cognitive Dysfunction* / psychology
Dementia* / psychology
Humans
Neuropsychological Tests
Psychomotor Agitation / complications