Contemporaneous symptom networks of neuropsychiatric symptoms in older adults with mild behavioural impairment: Insights from network analysis.

Background

Mild behavioural impairment (MBI), characterised by persistent late-life neuropsychiatric symptoms (NPS) in the absence of dementia, is a high-risk state for cognitive decline and dementia. NPS in MBI are diverse and associated with reduced quality of life and increased caregiver burden. However, little is known about the interactions among these symptoms.

Aim

To explore the interactions among NPS in older adults with MBI and identify symptom clusters, core symptoms, and bridge symptoms through network analysis.

Methods

A total of 328 older adults with MBI were enrolled using multistage cluster sampling from 42 nursing homes. Exploratory factor analysis (EFA) was performed to identify NPS clusters, and R software was used to construct a network layout describing the relationships between symptoms. Node centrality was calculated to determine the symptom's relative importance within the network.

Results

The analysis revealed connectivity patterns among NPS. EFA extracted two symptom clusters: agitation-irritability and anxiety-depression. Agitation emerged as the core symptom, exhibiting the highest strength, betweenness, and expected influence centrality. Apathy was identified as the bridge symptom, exhibiting the highest bridge strength connecting the two symptom clusters.

Conclusions

These network findings highlight agitation and apathy as key intervention targets in older adults with MBI. Given their central and bridging roles, agitation is strongly connected with multiple other NPS, while apathy serves as a bridge between symptom clusters. Clinically, prioritizing these symptoms may support a more efficient and personalized approach to NPS management; however, further longitudinal studies are needed to clarify their temporal relationships with dementia progression.