Behavioural symptoms are normally associated with moderate to severe stages of dementia. However, recent evidence suggests that these symptoms are present even in the preclinical stages of dementia, such as mild cognitive impairment (MCI).1 MCI is a disorder observed at a stage between normal aging and dementia,2 and may be a precursor to dementia.1 The estimated conversion rate from MCI to Alzheimer’s disease (AD) is between 10–15% per year over 5 years.2,3
Behavioural symptoms are not part of MCI diagnostic criteria, and their role in MCI and conversion to AD has yet to be established. Previous studies have suggested that depression, social withdrawal and diurnal rhythm changes are present as early symptoms of AD.4 Lyketsos et al., 20021 confirmed that behavioural symptoms occur in the majority of dementia patients, and also occur frequently in MCI.
Recently, the ‘Investigation in the Delay to Diagnosis of Alzheimer’s Disease with Exelon (rivastigmine)’ (InDDEx) study characterised the spectrum of neuropsychiatric symptoms present in 1,010 MCI patients, and their relationship to cognitive function, global function and activities of daily living. The results suggest that approximately 60% of MCI patients have accompanying neuropsychiatric symptoms, particularly depression, irritability, anxiety, agitation and apathy.5 At baseline, patients with behavioural symptoms were significantly more impaired with regards to cognitive, global and functional measures, than subjects with no behavioural symptoms.
The characterisation of neuropsychiatric symptoms in MCI is important as they may be a useful clinical marker for MCI and possibly indicate a greater likelihood of conversion to AD.
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