586. NEUROPSYCHIATRIC SYMPTOMS AS PREDICTORS FOR COGNITIVE IMPAIRMENT AND REVERT FACTORS FOR NORMAL COGNITION: A ONE-YEAR PROSPECTIVE COHORT STUDY

Abstract Background Mild cognitive impairment and mild behavioral impairment are considered pre-stage dementia. The two conditions are overlapped. Neuropsychiatric symptoms were significant risk factors for developing cognitive impairment from previous studies. Aims & Objectives This study aimed to explore neuropsychiatric symptoms as predicted factors for mild cognitive impairment conversion to dementia and mild cognitive impairment reversion to normal. Method This one-year prospective cohort study enrolled 793 participants aged 55 and older at baseline, including 24 individuals with Alzheimer's disease (AD), 269 with mild cognitive impairment (MCI), and 500 with normal cognition. Participants and their caregivers completed the Thai version of the Neuropsychiatric Inventory Questionnaire (NPI-Q) at baseline and again at 3, 6, 9, and 12 months. By the end of the study, 605 participants completed their evaluation, which included 16 AD participants, 193 MCI participants and 396 participants with normal cognition. Multivariate analysis, using multinomial and binary logistic regression, was performed to calculate the risk and odds ratios of neuropsychiatric factors associated with MCI conversion to AD and MCI reversion to normal cognition. Results Over the one-year study period, 4.15% of participants with MCI progressed to dementia, while 33.16% reverted to normal cognition. Neuropsychiatric symptoms were most prevalent in participants with AD, less common in those with MCI, and least common in individuals with normal cognition. Specifically, MCI participants who experienced delusions had a 346 times greater risk, and those with irritability a 3.8 times greater risk, of converting to dementia. When considering neuropsychiatric symptoms as indicators of Mild Behavioral Impairment (MBI) – defined as symptoms present, even intermittently, for at least six months (reported at three or more visits) – apathy (OR 23.8, 95% CI: 3.80-148.88), irritability/lability (OR 6.15, 95% CI: 1.38-27.496), and aberrant motor behavior (OR 5.03, 95% CI: 1.08-23.53) significantly increased the risk of MCI progressing to dementia. Discussion & Conclusions The study distinguished between neuropsychiatric symptoms that were present at any point and those that persisted over time as risk factors for dementia in MCI patients. MCI participants who experienced delusions and irritability had an increased risk of progressing to dementia. Additionally, those with persistent apathy, irritability, and abnormal motor behavior for at least six months faced a higher risk of conversion to dementia. However, no neuropsychiatric symptoms were significantly linked to the reversion from MCI to normal cognition.