Memory Aging & Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
St Luke's Medical Center, Quezon City, Philippines.
J Clin Psychiatry. 2022 Mar 16;83(3):21m14105. doi: 10.4088/JCP.21m14105.
Mild behavioral impairment (MBI) is characterized as later-life-emergent and persistent neuropsychiatric symptoms (NPS). The symptom persistence criterion of MBI has shown to increase the signal-to-noise ratio of the syndrome, decreasing the likelihood of false-positive NPS. However, the long-term cognitive and prognostic impact of MBI remains to be evaluated against the traditional framework of NPS, especially in Asian cohorts. This study investigated the epidemiologic characteristics of MBI in a prospective clinical cohort of Singaporean elderly. A total of 304 dementia-free individuals (mean [SD] age = 72.2 [8.0] years, 51.6% female) were recruited between August 2010 and October 2019. All participants underwent annual neuropsychological, neuropsychiatric, and clinical assessments for 4 consecutive years and were diagnosed as having no cognitive impairment (NCI) or cognitive impairment-no dementia (CIND). MBI was ascertained using both baseline and year-1 Neuropsychiatric Inventory assessments. Cognitive -scores and Clinical Dementia Rating Sum-of-Boxes (CDR-SoB) scores were calculated. The prevalence of MBI was 14.5% (7.1% of NCI, 12.9% of CIND-mild, and 24.7% of CIND-moderate patients). MBI patients showed poorer cognitive function at baseline ( = 8.13 [SE = 0.47], = .005), primarily in memory and executive function domains. MBI was associated with accelerated decline in global cognition ( = -0.15; 95% CI, -0.23 to -0.07) along with faster increase in CDR-SoB ( = 0.92; 95% CI, 0.62 to 1.21) as compared to individuals without symptoms or transient NPS. A total of 38.6% of MBI patients developed dementia as compared to 12.3% of non-MBI elderly (χ = 19.29, < .001). MBI increased risk of incident dementia by 2.56-fold as compared to no symptoms or transient NPS, regardless of cognitive impairment. MBI is a neurobehavioral risk factor for dementia, representing a potential target for dementia risk modeling, preventive intervention, and disease management.
轻度行为障碍 (MBI) 的特征为老年期出现和持续存在的神经精神症状 (NPS)。MBI 的症状持续标准已被证明可提高该综合征的信噪比，降低 NPS 假阳性的可能性。然而，MBI 的长期认知和预后影响仍需根据 NPS 的传统框架进行评估，特别是在亚洲队列中。本研究在新加坡老年人的前瞻性临床队列中调查了 MBI 的流行病学特征。2010 年 8 月至 2019 年 10 月期间共招募了 304 名无痴呆症个体（平均[标准差]年龄=72.2[8.0]岁，51.6%为女性）。所有参与者在连续 4 年内每年接受神经心理学、神经精神病学和临床评估，并被诊断为无认知障碍 (NCI) 或认知障碍-无痴呆 (CIND)。使用基线和第 1 年的神经精神病学问卷评估来确定 MBI。计算认知评分和临床痴呆评定量表总和分 (CDR-SoB)。MBI 的患病率为 14.5%（NCI 为 7.1%，CIND-轻度为 12.9%，CIND-中度为 24.7%）。MBI 患者在基线时的认知功能较差（=8.13[SE=0.47]，=0.005），主要在记忆和执行功能领域。与无症状或短暂 NPS 的个体相比，MBI 与全球认知功能的加速下降相关（=−0.15；95%CI，−0.23 至−0.07），与 CDR-SoB 的更快增加相关（=0.92；95%CI，0.62 至 1.21）。与非 MBI 老年人相比，MBI 患者中有 38.6%发展为痴呆（χ²=19.29，<0.001）。无论认知障碍如何，与无症状或短暂 NPS 相比，MBI 使发生痴呆的风险增加 2.56 倍。MBI 是痴呆的神经行为危险因素，代表痴呆风险建模、预防干预和疾病管理的潜在目标。
