Examining the Link Between Cardiovascular Risk Factors and Neuropsychiatric Symptoms in Mild Cognitive Impairment and Major Depressive Disorder in Remission

Article type: Research Article

Authors: Fischer, Corinne E.^{a; b; *} | Kortebi, Ines^c | Karameh, Wael K.^{a; d; f} | Kumar, Sanjeev^d | Gallagher, Damien^{c; e} | Golas, Angela^{a; d; f} | Munoz, David^{b; c} | Barfett, Joseph^{b; f} | Butters, Meryl A.^g | Bowie, Christopher R.^{d; h} | Flint, Alastair^{a; i} | Rajji, Tarek^{a; d} | Herrmann, Nathan^{a; e} | Pollock, Bruce G.^j | Mulsant, Benoit^{a; d} | Schweizer, Tom A.^{b; c; 1} | Mah, Linda^{a; k; 1} | and the PACT-MD Study Group

Affiliations: [a] Department of Psychiatry, University of Toronto, Toronto, Canada | [b] Keenan Research Centre for Biomedical Research, St. Michael’s Hospital, Toronto, Canada | [c] University of Toronto, Toronto, Canada | [d] Centre for Addiction and Mental Health, Toronto, Canada | [e] Sunnybrook Health Sciences Centre, Toronto, Canada | [f] St. Michael’s Hospital, Toronto, Canada | [g] Department of Psychiatry, University of Pittsburgh School of Medicine, USA | [h] Queen’s University, Kingston, Canada | [i] Centre for Mental Health, University Health Network, Toronto, Canada | [j] Campbell Family Mental Health Research Institute, Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada | [k] Rotman Research Institute, Baycrest Health Sciences Centre, Toronto, Canada

Correspondence: [*] Correspondence to: Dr. Corinne E. Fischer, St. Michael’s Hospital, 30 Bond St., Room 17-044 Cardinal Carter Wing, Toronto, ON, M5B 1W8, Canada. Tel.: +1 416 864 5320; E-mail: FISCHERC@smh.ca.

Note: [1] Co-senior authors.

Abstract: Background:Cardiovascular risk factors (CVRFs) have been linked to both depression and cognitive decline but their role in neuropsychiatric symptoms (NPS) has yet to be clarified. Objective:Understanding the role of CVRFs in the etiology of NPS for prospective treatments and preventive strategies to minimize these symptoms. Methods:We examined the distribution of NPS using the Neuropsychiatric Inventory (NPI) scores in three cohorts from the Prevention of Alzheimer’s Dementia with Cognitive Remediation Plus Transcranial Direct Current Stimulation in Mild Cognitive Impairment and Depression (PACt-MD) study: older patients with a lifetime history of major depressive disorder (MDD) in remission, patients with mild cognitive impairment (MCI), and patients with combined MCI and MDD. We also examined the link between individual NPS and CVRFs, Framingham risk score, and Hachinski ischemic score in a combined sample. Results:Analyses were based on a sample of 140 subjects, 70 with MCI, 38 with MCI plus MDD, and 32 with MDD. There was no effect of age, gender, education, cognition, or CVRFs on the presence (NPI >1) or absence (NPI = 0) of NPS. Depression was the most prevalent affective NPS domain followed by night-time behaviors and appetite changes across all three diagnostic groups. Agitation and aggression correlated negatively while anxiety, disinhibition, night-time behaviors, and irritability correlated positively with CVRFs (all p-values <0.05). Other NPS domains showed no significant association with CVRFs. Conclusion:CVRFs are significantly associated with individual NPI sub-scores but not with total NPI scores, suggesting that different pathologies may contribute to different NPS domains.

Keywords: Affective symptoms, sep alzheimer’s disease, sep cardiovascular diseases, sep cognitive dysfunction, sep dementia, sep major depressive disorder, sep mental status and dementia tests, sep neurobehavioral manifestations

DOI: 10.3233/JAD-181099

Journal: Journal of Alzheimer's Disease, vol. 67, no. 4, pp. 1305-1311, 2019