Non-cognitive symptoms as early indicators of Dementia: a preliminary retrospective study from a Psychiatric outpatient clinic

INTRODUCTION: Neuropsychiatric symptoms (NPS) may signal dementia risk or early pathology, yet clinical evidence regarding the association between pre-diagnostic NPS and outcomes remains limited. This preliminary study explored NPS features and their potential associations with dementia progression. METHODS: The study was conducted on 201 dementia patients from Shanghai Mental Health Center (ICD-10 diagnosed). NPS history was extracted from medical records. Statistical analyses included chi-square tests (demographics/subtypes), ANOVA (preclinical intervals), and logistic regression (AD vs. non-AD factors). RESULTS: 69.2% of patients had pre-dementia NPS, which was associated with a shorter interval to dementia (23.4 vs. 42.2 months, p < 0.001) and a higher likelihood of non-AD dementia risk. Psychiatric disorders (74.1%) were the most prevalent NPS domain, followed by sleep disturbances (46.8%) and affective dysregulation (39.8%), with psychiatric symptoms showing the shortest dementia transition (34.3 ± 37.8 months). Females exhibited higher hallucination/delusion rates than males (30.2% vs. 15.4%; 26.2% vs. 9.6%). AD predominated (68.7%), followed by DLB (12.4%) and others. Psychiatric-to-dementia intervals differed significantly between AD (52.3 ± 47.6months) and DLB (26.5 ± 19.9months). Female sex, hallucinations, and behavioral dysregulation were identified as independent factors associated with AD (p < 0.05). CONCLUSION: Pre-dementia NPS, particularly psychiatric manifestations, may link to early dementia. However, given the exploratory nature of the results, which is needed to confirm these findings. Clinicians should consider prodromal dementia in older adults with late-onset psychiatric symptoms to enable early intervention.