Cognitive impairments predict the behavioral and psychological symptoms of dementia

Solaphat Hemrungrojn; Sookjaroen Tangwongchai; Thammanard Charernboon; Muthita Phanasathit; Pisit Chaipresertsud; Pacharaporn Maleevach; Yuttachai Likitjaroen; Kammant Phanthumchinda; Ratiya Assawatinna; Arisara Amrapala; Michael Maes

doi:10.3389/fneur.2023.1194917

Cognitive impairments predict the behavioral and psychological symptoms of dementia

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

Authors

Solaphat Hemrungrojn^{1

2}, Sookjaroen Tangwongchai^{1

3}, Thammanard Charernboon⁴, Muthita Phanasathit⁵, Pisit Chaipresertsud⁶, Pacharaporn Maleevach⁷, Yuttachai Likitjaroen⁸, Kammant Phanthumchinda⁸, Ratiya Assawatinna², Arisara Amrapala^{1

2}, Michael Maes^{1

2

3

9

10

10

11}

Affiliations

¹ Department of Psychiatry, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand.
² Cognitive Fitness and Biopsychiatry Technology Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
³ Cognitive Impairment and Dementia Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
⁴ Department of Clinical Epidemiology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
⁵ Department of Psychiatry, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
⁶ Chao Phraya Abhaibhubejhr Hospital, Prachinburi, Thailand.
⁷ Angthong Hospital, Ang Thong, Thailand.
⁸ Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
⁹ Department of Psychiatry, Medical University of Plovdiv and Technological Center for Emergency Medicine, Plovdiv, Bulgaria.
¹⁰ Mental Health Center, University of Electronic Science and Technology of China, Chengdu, China.
¹¹ Research Institute, Medical University of Plovdiv, Plovdiv, Bulgaria.

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.