Neuropsychiatric Symptoms in Mild Cognitive Impairment: An Analysis and Its Impact on Caregiving

Article excerpt

Byline: Surbhi. Trivedi, Alka. Subramanyam, Charles. Pinto, Dhananjay. Gambhire

Abstract 0Background: Neuropsychiatric impairments play a significant role throughout the course of cognitive decline. Many psychological and behavioral symptoms are present in patients of mild cognitive impairment (MCI) similar to that seen in individuals with dementia. Aims and Objectives: To study the relevance of neuropsychiatric symptoms of MCI and the impact it has on caregivers of these patients. Materials and Methods: This cross-sectional study was done on 90 patients (30 MCI, 30 dementia and 30 controls) above the age of 50 years. The scales used were Hindi-Mental Status Examination, Global deterioration scale and Neuropsychiatric inventory (NPI). Statistical analysis was done using SPSS 16 software. Results: 73.33% (22) of the subjects in MCI group, 90% (27) of subjects in dementia group and 53.33% (16) of subjects having normal cognition had neuropsychiatric complaints. 73.33% (22) relatives of subjects in the MCI group, 90% (27) relatives of subjects in dementia group and 46.67% (14) relatives of subjects in the normal group (i.e. control group) experienced some distress. The differences in the mean NPI severity, frequency, distress and total scores of the three groups were statistically significant. Severity and frequency of neuropsychiatric symptoms significantly predicted the caregiver's distress. Conclusions: Neuropsychiatric symptoms increase both in frequency and severity with increasing cognitive decline, and they cause distress both to the patient as well as the caregiver; and hence their early recognition is a must. The NPI appears to be a useful tool in that regard.

Introduction

"Youth lives on hope, old age on memories" -Anon;

And it is these memories that Alzheimer's disease (AD) gradually washes away. As public awareness of AD is increasing, more people are asking for help and advice about memory problems. [sup][1] With our expanding knowledge of dementia and dementing illnesses it is becoming clearer that the pathological changes in the brain precede the development of clinically evident AD, by many years, perhaps even decades. [sup][2] Hence the field of ageing and dementia is now focusing on the characterization of the earliest stages of cognitive impairment. Research has identified a transitional state between the cognitive changes that occur in normal ageing and AD known as mild cognitive impairment (MCI). [sup][3]

Clinically, MCI can be defined as impairment in one or more cognitive domains-typically memory, or an overall mild decline across all cognitive abilities that is greater than would be expected for individual age or education but insufficient to interfere with social and occupational functioning as is required for a dementia syndrome. The concept of MCI was first described by Peterson in 1997 who described it along a continuum between normal ageing and dementia. [sup][4] The American Academy of Neurology has defined MCI as having memory complaints preferably corroborated by an informant, objective memory impairment, normal general cognitive functioning, intact activities of daily living and not demented. [sup][5] The diagnostic criteria have been now extended to include individuals whose memory complaint is expressed by an informant, individuals with intact memory but significant impairment of a non-memory cognitive function and individuals with some impairment in complex instrumental activities of daily living. [sup][6]

As for dementia, the incidence rates of pre-dementia syndrome appear to increase with age and are higher in subject's with less education. [sup][7] The reported prevalence of pre-dementia syndromes varies between studies as a result of different diagnostic criteria, as well as different sampling and assessment procedures. [sup][8] The rate of development of MCI has been found to be about 5.3% per year (3.5% in the seventh decade of life and 7. …