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O1‐13‐03: The Mild Behavioral Impairment Checklist (MBI‐C): a New Rating Scale for Neuropsychiatric Symptoms as Early Manifestations of Neurodegenerative Disease
Author(s) -
Ismail Zahinoor,
Brodaty Henry,
Cieslak Alicja,
Fischer Corinne E.,
Gauthier Serge,
Geda Yonas E.,
Herrmann Nathan,
Kanji Jamila,
Lanctot Krista L.,
Miller David,
Mortby Moyra E.,
Onyike Chiadikaobi,
Ortiz Luis Aguera,
Rosenberg Paul,
Smith Eric E.,
Smith Gwenn S.,
Sultzer David,
Cummings Jeffrey L.,
Lyketsos Constantine
Publication year - 2016
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2016.06.366
Subject(s) - apathy , dementia , psychology , psychiatry , rating scale , mood , neuropathology , clinical psychology , checklist , clinical dementia rating , cognition , caregiver burden , disease , medicine , cognitive impairment , developmental psychology , pathology , cognitive psychology
for 32 weeks, 2) risperidone for 16 weeks and then switch to placebo for 16 weeks or 3) placebo for 32 weeks. Discontinuation of risperidone was associated with a 2-4 fold increased risk of relapse over 16-32 weeks (ADAD trial, Devanand et al, NEJM 2012). In planned posthoc analyses, we examined associations between the 12 symptom domains in the Neuropsychiatric Inventory (NPI) and the likelihood of relapse in this trial. Results:Hallucinations at baseline showed a significant association with relapse during the first 16 weeks after randomization. Compared to patients with no hallucinations or mild hallucinations, patients with severe hallucinations at baseline were more likely to relapse (HR 2.956, 95% CI 1.518 to 5.755, p1⁄40.0014). This difference was present for the subsample with auditory hallucinations (HR1⁄42.402, 95% CI 1.285 to 4.490, p1⁄40.006) but not for those with visual hallucinations. Furthermore, severe hallucinations were associated with greater relapse in patients randomized to risperidone discontinuation (switch to placebo) than in those randomized to risperidone continuation (HR 2.512, 95% CI 1.257 to 5.019, p1⁄40.009). Among patients with baseline hallucinations, 13 of 17 patients (76.5%) who discontinued risperidone relapsed, compared to 10 of 26 patients (38.5%) who continued risperidone (p1⁄40.0149). This difference was also observed for severe (77.8%) compared to mild (36%) hallucinations (p1⁄40.0231) and for those with auditory but not visual hallucinations. Residual symptoms at the time-point of randomization did not predict relapse. Conclusions: For patients with severe hallucinations, particularly auditory hallucinations, antipsychotic discontinuation may not be advisable because of high relapse risk. If discontinuation is attempted, close monitoring for relapse with prompt reinstitution of antipsychotic treatment may be necessary.