Neuropsychiatric symptoms as risk factors for progression from CIND to dementia: the Cache County Study

Am J Geriatr Psychiatry. 2013 Nov;21(11):1116-24. doi: 10.1016/j.jagp.2013.01.049. Epub 2013 Feb 6.


Objectives: To examine the association of neuropsychiatric symptom (NPS) severity with risk of transition to all-cause dementia, Alzheimer disease (AD), and vascular dementia (VaD).

Design: Survival analysis of time to dementia, AD, or VaD onset.

Setting: Population-based study.

Participants: 230 participants diagnosed with cognitive impairment, no dementia (CIND) from the Cache County Study of Memory Health and Aging were followed for a mean of 3.3 years.

Measurements: The Neuropsychiatric Inventory (NPI) was used to quantify the presence, frequency, and severity of NPS. Chi-squared statistics, t-tests, and Cox proportional hazard ratios were used to assess associations.

Results: The conversion rate from CIND to all-cause dementia was 12% per year, with risk factors including an APOE ε4 allele, lower Mini-Mental State Examination, lower 3MS, and higher CDR sum-of-boxes. The presence of at least one NPS was a risk factor for all-cause dementia, as was the presence of NPS with mild severity. Nighttime behaviors were a risk factor for all-cause dementia and of AD, whereas hallucinations were a risk factor for VaD.

Conclusions: These data confirm that NPS are risk factors for conversion from CIND to dementia. Of special interest is that even NPS of mild severity are a risk for all-cause dementia or AD.

Keywords: Agitation; CIND; Cache County; MCI; NPI; NPS; anxiety; dementia; depression.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged, 80 and over
  • Alzheimer Disease / complications
  • Alzheimer Disease / psychology
  • Cognition Disorders / complications
  • Cognition Disorders / psychology*
  • Dementia / complications
  • Dementia / psychology*
  • Disease Progression*
  • Female
  • Humans
  • Male
  • Mental Disorders / complications
  • Mental Disorders / diagnosis*
  • Mental Disorders / psychology
  • Models, Statistical*
  • Neuropsychological Tests
  • Psychiatric Status Rating Scales / statistics & numerical data
  • Risk Factors