Neuropsychiatric Symptoms Predict Faster Cognitive Decline in Dementia Collaborative Care Than Antipsychotic Use

Abstract

Background

To compare short-term cognitive outcomes among groups with and without neuropsychiatric symptoms (NPSs) or antipsychotic prescription and to determine which disease status or treatment modality is associated with relatively faster cognitive decline.

Methods

We retrospectively analyzed a prospective cohort of patients diagnosed with dementia and mild cognitive impairment. All participants were evaluated using the Cognitive Abilities Screening Instrument (CASI) during their initial clinical assessments and at the annual follow-up. The dependent variable was annual delta CASI. Multivariate linear regression analysis was used to assess the degree of association between NPS, antipsychotic use, and cognitive decline after adjusting for confounding factors. Neuropsychiatric symptoms were examined individually to determine their predictive value for cognitive decline.

Results

A total of 407 (N = 407) patients were included in the study. NPSs, rather than antipsychotic use, led to faster cognitive decline. A higher baseline NPI total score predicted a significantly faster decline in CASI scores (1-year delta CASI = −0.22, 95% CI = −0.38~ −0.05, p = 0.010). Specific items (delusions, agitation, depression, anxiety, euphoria, and apathy) in the NPS significantly increased cognitive decline.

Conclusion

Certain neuropsychiatric symptoms, rather than antipsychotic use, lead to faster cognitive decline in a dementia collaborative care model. Checking for and providing appropriate interventions for NPS in people with dementia and their caregivers are highlighted.

Keywords:

• neuropsychiatric symptoms
• antipsychotics
• cognitive decline
• cognitive abilities screening instrument
• dementia collaborative care

Data Sharing Statement

The raw data supporting the conclusions of this article will be made available by the corresponding author, without undue reservation.

Ethics Approval & Patient Consent Statement

This clinical study was approved by the Institutional Review Board of Changhua Christian Hospital (CCH IRB 220920). The requirement for informed consent from each participant was waived by the institutional review board because of the retrospective chart review design. Attentions were paid on minimal risk of patient data confidentiality and the study was in compliance with the Declaration of Helsinki.

Disclosure

Yen-Jen Chen, Ming-Che Chang, Kai-Ming Jhang and Wen-Fu Wang contributed equally to this work and share first authorship. The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Additional information

Funding

This study was supported by CCH Grants 112-CCH-IRP-020. The funding source had no role in the design of this study, execution, analyses, or interpretation of the data.