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

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, mortal-ity and cognitive deterioration (increase & GE;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 hyper-active and apathetic behavior domain. Across the whole cohort, affective behav-ior 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. (Am J Geriatr Psychiatry 2022; 30:813-824)

Automated summary

This study examines the association between neuropsychiatric symptoms (NPS) and clinical outcomes in memory clinic patients with possible Vascular Cognitive Impairment (VCI). The findings reveal that NPS are common in this patient group and are associated with institutionalization, mortality, and cognitive deterioration. The association between NPS and clinical outcomes varies depending on the severity of cognitive impairment.