Objective: To investigate the influence of neuropsychiatric symptoms (NPS) on early cognitive decline in patients with Lewy body disease (LBD).

Background: NPS in LBD, including dementia with Lewy bodies (DLB) and Parkinson’s disease (PD) dementia, occur frequently and early on in disease progression. Such symptoms are significantly associated with quality of life, caregiver burden and functional limitations. Limited evidence exists, however, outlining the relationship between NPS and cognitive decline.

Method: Data from 211 participants were derived from three cohort studies. Patients with a mild cognitive impairment (MCI) with either probable DLB (MCI-LB, n = 67), PD (PD-MCI, n = 50) or Alzheimer’s disease (MCI-AD, n = 39), as well as a group of healthy older adults (n = 55), completed comprehensive neuropsychological and neuropsychiatric assessment and were followed up longitudinally for a median of three years. NPS identified at baseline by the Neuropsychiatric Inventory (NPI) were included as predictors in linear regressions and linear mixed effects models to assess the relationship between NPS and cognitive performance both at baseline and longitudinally.

Results: At baseline, NPS were most prevalent and severe among the MCI-LB group (70% with an NPI score ≥4 in at least one symptom) and least prevalent in controls (15% with an NPI score ≥4). Total NPI score was not related to baseline cognitive function in any domain in any group but was associated with steeper rates of decline in processing speed among PD-MCI patients (p = .007). No patient group showed associations between individual NPS and rate of decline in global cognition, however, at baseline, anxiety in PD-MCI patients was significantly predictive of lower scores on the Mini Mental State Examination (p =.002). With the exception of MCI-AD, all groups further demonstrated a relationship between agitative symptoms and change over time in reaction times.

Conclusion: The lack of a significant relationship between total NPI score and decline in global cognition among MCI-LB patients in this study suggests that, at this prodromal stage of disease, general NPS burden appears to be of limited clinical impact in DLB. However, these findings indicate that mechanisms underlying specific NPS may overlap with those underlying domain-specific declines characteristic of LBD. Future work will investigate these mechanisms using multimodal imaging data from this cohort.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/predicting-cognitive-decline-using-neuropsychiatric-symptoms-in-prodromal-lewy-body-disease/