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Population-Based Study

Yonas E. Geda, MD, MSc; Rosebud O. Roberts, MB, ChB, MS; David S. Knopman, MD; Ronald C. Petersen, MD, PhD; Teresa J. H. Christianson, BSc; Vernon S. Pankratz, PhD; Glenn E. Smith, PhD; Bradley F. Boeve, MD; Robert J. Ivnik, PhD; Eric G. Tangalos, MD; Walter A. Rocca, MD, MPH

Arch Gen Psychiatry. 2008;65(10):1193-1198.

Context  Little is known about the population-based prevalence of neuropsychiatric symptoms in mild cognitive impairment (MCI).

Objective  To estimate the prevalence of neuropsychiatric symptoms in MCI and normal cognitive aging in a defined population.

Design  Cross-sectional study derived from an ongoing population-based prospective cohort study.

Setting  The Mayo Clinic Study of Aging.

Participants  We studied a random sample of 1969 individuals without dementia from the target population of 9965 elderly persons residing in Olmsted County (Minnesota) on the prevalence date (October 1, 2004). Neuropsychiatric data were available for 319 of 329 subjects with MCI (97.0%) and 1590 of 1640 subjects with normal cognition (97.0%). Neurologic, cognitive, and neuropsychiatric data were obtained from the study participants. A classification of MCI, dementia, and normal cognitive aging was adjudicated by an expert consensus panel. Accordingly, 329 subjects were classified as having MCI and the remaining 1640 subjects were classified as having normal cognition.

Main Outcome Measure  Neuropsychiatric Inventory Questionnaire score.

Results  Multivariate logistic regression analyses were conducted after adjusting for age, sex, and educational status. By considering both the odds ratio (OR) and the frequency of a symptom, the most distinguishing features between the 2 groups were apathy (OR, 4.53; 95% confidence interval [CI], 3.11-6.60; P < .001), agitation (3.60; 2.18-5.92; P < .001), anxiety (3.00; 2.01-4.48; P < .001), irritability 2.99; 2.11-4.22; P < .001), and depression (2.78; 2.06-3.76; P < .001). The OR was highest for delusion (8.12; 95% CI, 2.92-22.60; P < .001); however, it was rare in both subjects with MCI (11 of 319 [3.4%]) and those with normal cognition (6 of 1590 [0.4%]). Thus, the population attributable risk for delusion was only 2.62% compared with 14.60% for apathy.

Conclusions  Nonpsychotic symptoms affected approximately 50% of subjects with MCI and 25% of subjects with normal cognition. In contrast, psychotic symptoms were rare.

Author Affiliations: Department of Psychiatry and Psychology (Drs Geda, Smith, and Ivnik), Neurology (Drs Knopman, Petersen, Boeve, and Rocca), Health Sciences Research, Divisions of Epidemiology (Drs Geda, Roberts, and Rocca), Biostatistics (Ms Christianson and Dr Pankratz), and Primary Care Internal Medicine (Dr Tangalos), College of Medicine, Mayo Clinic, Rochester, Minnesota.

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