Abstract
Epidemiological studies have revealed that behavioral and psychological (or non-cognitive) symptoms are risk factors for cognitive decline in older adults. This study aimed to systematically review the literature and determine which behavioral and psychological symptoms are most predictive of future cognitive decline among individuals with no pre-existing cognitive impairments. The selected studies included middle-aged or older adults without cognitive impairments. The predictors were assessed using behavioral and psychological questionnaires, or diagnostic interviews, to identify non-cognitive symptoms or psychiatric clinical conditions. The follow-up period was at least one year, and the design of the selected studies was either retrospective or prospective. This study compared individuals with and without non-cognitive manifestations and resulted in one of three outcomes: (a) a score change on a cognitive measure, (b) a diagnosis of mild cognitive impairment, or (c) a diagnosis of Alzheimer’s disease or dementia. Four online databases were searched for eligible studies from the database inception to January 17, 2017: MEDLINE (PubMed), Embase (OVID), PsycINFO, and Web of Science. Pooled effect sizes were estimated using a random-effect model. Higgins I2, the Q statistic, and tau-squared were used to quantify the observed heterogeneity between the studies. Results indicate that depression and sleep duration (long and short) were the most consistent associations between behavioral or psychological symptoms and cognitive decline. This meta-analysis supports the need to assess behavioral and psychological symptoms in cognitively intact older adults to identify those who are at risk for cognitive decline.
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References
* References marked with an asterisk were included in the systematic review and meta-analysis, some details of which appear only in the Supplementary material.
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Acknowledgements
This study is part of the Quebec Consortium for the Early Identification of Alzheimer’s disease (CIMA-Q), funded by the Fonds d’Innovation Pfizer-FRQS and the Quebec Network for Research on Aging (RQRV) of the Fonds de Recherche du Québec-Santé and Fondation Courtois. JFG holds a Canada Research Chair on Cognitive Decline in Pathological Aging. SG is supported by FRQS J2 salary award. SB holds a Canada Research Chair on Cognitive Neuroscience of Aging and Brain Plasticity. The present authors want to thank the members of the CIMA-Q Cognition Group who are not listed as authors (Ana Ines Ansaldo, Isabelle Rouleau, Natasha Rajah, Howard Chertkow, Natalie Philips, Dominique Lorrain, Stéphane Poulin, and Simona Brambati) for their contribution in the preparatory phase of this systematic review and meta-analysis. We also thank the Support for People and Patient-Oriented Research and Trials (SUPPORT) Unit of Québec for its help and guidance through all stages of the current study. Finally, we thank Christine St-Pierre for her advices on methodology and Alain Gendron for his assistance with the search strategy.
Funding
This research was funded by the Fond d’innovation Pfizer-FRQS sur la maladie d’Alzheimer et les maladies apparentées.
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Hudon, C., Escudier, F., De Roy, J. et al. Behavioral and Psychological Symptoms that Predict Cognitive Decline or Impairment in Cognitively Normal Middle-Aged or Older Adults: a Meta-Analysis. Neuropsychol Rev 30, 558–579 (2020). https://doi.org/10.1007/s11065-020-09437-5
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DOI: https://doi.org/10.1007/s11065-020-09437-5