Neuropsychiatric Symptoms Predict Faster Cognitive Decline in Dementia Collaborative Care Than Antipsychotic Use

Yen-Jen Chen,1,2,* Ming-Che Chang,3,* Kai-Ming Jhang,4,* Wen-Fu Wang,4,* Yi-Cheng Liao1 1Department of Psychiatry, Changhua Christian Hospital, Changhua, Taiwan; 2Department of Psychiatry, Yuanlin Christian Hospital, Changhua, Taiwan; 3Department of Nuclear Medicine, Changhua Christian Hospital, Changhua, Taiwan; 4Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan*These authors contributed equally to this workCorrespondence: Yi-Cheng Liao, Department of Psychiatry, Changhua Christian Hospital, 135, Nan-Xiao St, Changhua, 500, Taiwan, Tel +886 4 7238595 ext. 7160, Fax +886 4-7251004, Email 40202@cch.org.twBackground: To compare short-term cognitive outcomes among groups with and without neuropsychiatric symptoms (NPSs) or antipsychotic prescription and to determine which disease status or treatment modality is associated with relatively faster cognitive decline.Methods: We retrospectively analyzed a prospective cohort of patients diagnosed with dementia and mild cognitive impairment. All participants were evaluated using the Cognitive Abilities Screening Instrument (CASI) during their initial clinical assessments and at the annual follow-up. The dependent variable was annual delta CASI. Multivariate linear regression analysis was used to assess the degree of association between NPS, antipsychotic use, and cognitive decline after adjusting for confounding factors. Neuropsychiatric symptoms were examined individually to determine their predictive value for cognitive decline.Results: A total of 407 (N = 407) patients were included in the study. NPSs, rather than antipsychotic use, led to faster cognitive decline. A higher baseline NPI total score predicted a significantly faster decline in CASI scores (1-year delta CASI = − 0.22, 95% CI = − 0.38~ − 0.05, p = 0.010). Specific items (delusions, agitation, depression, anxiety, euphoria, and apathy) in the NPS significantly increased cognitive decline.Conclusion: Certain neuropsychiatric symptoms, rather than antipsychotic use, lead to faster cognitive decline in a dementia collaborative care model. Checking for and providing appropriate interventions for NPS in people with dementia and their caregivers are highlighted.Keywords: neuropsychiatric symptoms, antipsychotics, cognitive decline, cognitive abilities screening instrument, dementia collaborative care