title: Neuropsychiatric symptoms in amnestic mild cognitive impairment: increased risk and faster progression to dementia.
abstract: BACKGROUND
  Neuropsychiatric symptoms (NPS) are common in mild cognitive impairment (MCI) but its role as a predictive factor for the progression to dementia is still not clear. The objective of this study is to identify NPS that predict the progression from amnestic MCI (a-MCI) to dementia using an easy to administer screening tool for NPS.
  
  
  METHODS
  132 patients with a-MCI were assessed for NPS by the Neuropsychiatric Inventory (NPI) and followed to detect progression to dementia.
  
  
  RESULTS
  The mean follow-up time was 3.5±2.9 years and rate of progression to dementia 28.8%. Two items of NPI were found to be independent risk factors for progression, nighttime behavioural disturbance (hazard ratio(HR)=2.2, 95%CI=1.10-4.43), anxiety (HR=2.5, 95%CI=1.01-6.20) and apathy (HR=2.2, 95%CI=1.003-4.820). The risk of progression increased with higher score on NPI (HR=1.046 per point, 95%CI=1.019- 1.073), and with a higher number of items of NPI affected (HR=3.6 per item, 95%CI=2.0-6.4). Faster progression to dementia was observed in patients with either nighttime behavioural disturbance, apathy or anxiety (4.6 vs. 8.3 years, 5.3 vs. 8.4 years and 3.0 vs. 7.7 years respectively, p < 0.01) as well as in those with a higher number of items affected (no items = 9.2 years, 1-3 items = 6.6 years and > 3 items = 2.9 years, p < 0.001).
  
  
  CONCLUSIONS
  Assessing a broad spectrum of NPS can help identify patients with a-MCI presenting a higher risk for progression to dementia. This can be useful to select patients for closer follow-up, clinical trials and future therapeutic interventions.
authors.affiliation: Memory Unit, Department of Neurology, Hospital de Cruces, Baracaldo, Vizcaya, Spain. johanne_somme@hotmail.com
authors.forename: Johanne
authors.initials: J
authors.lastname: Somme
authors.forename: Manuel
authors.initials: M
authors.lastname: Fernández-Martínez
authors.forename: Ana
authors.initials: A
authors.lastname: Molano
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Zarranz
mesh_terms: D000368:Aged; D060825:Cognitive Dysfunction / Q000150:complications*; D003704:Dementia / Q000503:physiopathology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000209:etiology*; D008609:Mental Status Schedule; D008875:Middle Aged; D009483:Neuropsychological Tests; D012189:Retrospective Studies; D018709:Statistics, Nonparametric