I thought that neuropsychiatric meant disorders like delirium from infection. Wrong. It includes everything psychiatric except things that are truly mechanical like strokes. So neuropsychiatric includes depression, anxiety, ADHD, all of it. Why is it neuropsychiatric rather than just psychiatric?


“Neuropsychiatric symptoms are non-cognitive disturbances such as depression. Rates of NPS have been shown to increase as cognitive ability declines and may be useful in predicting transition from mild cognitive impairment (MCI) to dementia.”


“This community-based study reports the association between NPS and cognitive decline over two years. Participants included 873 community dwelling adults aged 70-90 years enrolled in the Sydney Memory and Ageing Study. NPS were assessed by the Neuropsychiatric Inventory (NPI), Cognitive impairment was defined by diagnosis (MCI or incident dementia) or neuropsychological test performance across five cognitive domains. Cognitive decline was defined by progression to dementia or worse neuropsychological performance. Total NPS at baseline did not differ between those without cognitive impairment (26.2%) and those with MCI (28.8%), but agitation and apathy were associated with MCI. Only baseline depression was associated with dementia at follow-up. Total NPS at baseline was cross-sectionally associated with cognitive impairment in executive function, attention, and global cognition, but did not predict cognitive decline. Depression, anxiety, agitation and apathy were all associated with impairment in at least one cognitive domain, but only anxiety and agitation were significantly associated with cognitive decline. Sensitivity analyses applied more stringent criteria for NPS and cognitive impairment in MCI but did not alter interpretation of results from the main analysis. Overall rates of NPS at baseline were not associated with MCI, dementia, or cognitive decline over two years. Additional follow-up is needed to further examine this association over a longer time course.”

Ok, let me do some translating.

This is a community-based study. So they are studying healthy elders who are not in nursing homes, age 70-90. If you plan to live to 90, you want to be one of these, right?

They did neuropsych testing and testing for dementia. 26.2 % had no cognitive impairment at the start, the baseline, and 28.8 % had mild cognitive impairment (MCI). They defined cognitive decline as worsening either of memory (dementia) OR neuropsychological: depression/anxiety/etc new diagnosis or worse. Only baseline depression correlated with dementia at the two year point.

The initial total NPS was associated with cognitive impairment at the two year point, but did not predict cognitive decline.

Anxiety and agitation were associated strongly with cognitive decline, but not depression or apathy as much. They tried fine tuning the data and it didn’t change.

Overall rates of NPS at baseline were not associated with MCI, dementia or cognitive decline over two years. So Uncle Hurly may be bipolar as hell and that still does not mean he will get memory loss.

With the anxiety and agitation, it’s a chicken and egg thing. Does the cognitive decline trigger anxiety and agitation or the reverse or do they feed each other? Time for more slow breathing, right? And not too much alcohol because the withdrawal makes you anxious. Ditto pot, don’t take it for sleep. Hello addiction. Our nursing home does not officially allow any THC or CBD products. The medical assistants and RNs will not apply CBD oil to your mother. Or you.
My understanding is enlarged and neuropsychiatric did not mean what I think it did. What is the corresponding term though? Unneuropsychiatric? Seems a bit clumsy. Perhaps one just says stroke, brain tumor, brain surgery, drug side effect or traumatic brain injury (TBI).

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