title: Association of neuropsychiatric symptoms and sub-syndromes with cognitive impairment in community-dwelling Asian elderly.
abstract: OBJECTIVE
  To investigate the presence of neuropsychiatric symptoms (NPS) and sub-syndromes in elderly community-dwelling Asians with varying severity of cognitive impairment.
  
  
  METHODS
  Chinese and Malay participants (n = 613) from the Epidemiology of Dementia in Singapore (EDIS) Study aged ≥ 60 years underwent clinical examination, neuropsychological testing, and NPS assessment using the Neuropsychiatric Inventory (NPI). Diagnosis of no cognitive impairment (NCI), cognitive impairment-no dementia (CIND), including CIND-mild and CIND-moderate, and dementia were made using established criteria.
  
  
  RESULTS
  A significant increase in the numbers of NPS was observed accompanying with increasing severity of cognitive impairment (p < 0.001). Compared to those with NCI/CIND-mild, participants with CIND-moderate [Odds ratio (OR): 4.2, 95% confidence interval (CI): 1.8-10.0] or dementia [OR: 9.2, 95% CI: 2.3-36.0] were more likely to have two or more neuropsychiatric sub-syndromes. Participants with CIND-moderate were more likely to have hyperactivity [OR: 2.0, 95% CI: 1.0-3.8] and apathy [OR: 2.9, 95% CI: 1.0-8.4] sub-syndromes, whereas patients with dementia were more likely to have psychosis [OR: 6.9, 95% CI: 2.4-20.1], affective (OR: 8.7, 95% CI: 1.8-42.9), and hyperactivity (OR: 5.4, 95% CI: 1.8-16.1). Furthermore, executive dysfunction and visual memory impairment were associated with the presence of three neuropsychiatric sub-syndromes; whist language and visuomotor speed impairment were related to the presence of two sub-syndromes. By contrast, impairment in attention, verbal memory, and visuoconstruction were not associated with any of the sub-syndromes.
  
  
  CONCLUSIONS
  The presence of NPS and sub-syndromes increase with increasing severities of cognitive impairment, and different neuropsychiatric syndromes are associated with specific impairment on cognitive domains in community-dwelling Asian elderly.
authors.affiliation: Memory Ageing and Cognition Centre (MACC),National University Health System,Singapore.
authors.forename: Xin
authors.initials: X
authors.lastname: Xu
authors.affiliation: Memory Ageing and Cognition Centre (MACC),National University Health System,Singapore.
authors.forename: Seow Li
authors.initials: SL
authors.lastname: Ang
authors.affiliation: Memory Ageing and Cognition Centre (MACC),National University Health System,Singapore.
authors.forename: Saima
authors.initials: S
authors.lastname: Hilal
authors.affiliation: Memory Ageing and Cognition Centre (MACC),National University Health System,Singapore.
authors.forename: Qun Lin
authors.initials: QL
authors.lastname: Chan
authors.affiliation: Singapore Eye Research Institute,Singapore National Eye Center,Singapore.
authors.forename: Tien Yin
authors.initials: TY
authors.lastname: Wong
authors.affiliation: Raffles Neuroscience Centre,Raffles Hospital,Singapore.
authors.forename: Narayanaswamy
authors.initials: N
authors.lastname: Venketasubramanian
authors.affiliation: Memory Ageing and Cognition Centre (MACC),National University Health System,Singapore.
authors.forename: Mohammad Kamran
authors.initials: MK
authors.lastname: Ikram
authors.affiliation: Memory Ageing and Cognition Centre (MACC),National University Health System,Singapore.
authors.forename: Christopher Li-Hsian
authors.initials: CL
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057565:Apathy; D003072:Cognition Disorders / Q000150:complications* / Q000523:psychology; D060825:Cognitive Dysfunction / Q000150:complications / Q000523:psychology; D003704:Dementia / Q000150:complications* / Q000523:psychology; D056344:Executive Function; D005260:Female; D006801:Humans; D057187:Independent Living / Q000523:psychology / Q000706:statistics & numerical data; D008297:Male; D008569:Memory Disorders / Q000150:complications / Q000523:psychology; D008875:Middle Aged; D009483:Neuropsychological Tests; D011595:Psychomotor Agitation / Q000150:complications / Q000523:psychology; D011618:Psychotic Disorders / Q000150:complications / Q000523:psychology; D012846:Singapore / Q000453:epidemiology; D013577:Syndrome
keywords: Asian; community dwelling; neuropsychiatric symptoms; sub-syndromes