Comparing self and informant perspectives on neuropsychiatric symptoms in older adults in a memory clinic

Abstract

BackgroundIn individuals with cognitive deficit, neuropsychiatric symptoms (NPS) are typically assessed through informant-based reports. In contrast, affective symptoms in cognitively normal individuals are typically evaluated using self-report measures, leveraging their sufficient insight. Comparison of these assessments in previous studies indicated differences in their perspectives.ObjectiveWe aimed to analyze differences between self- and informant-reported NPS using the Mild Behavioral Impairment-Checklist (MBI-C) and their relationship with cognitive deficit.MethodsThe study included 127 participant-informant dyads from a memory clinic cohort, classified as subjective cognitive decline (SCD; N = 38) or mild cognitive impairment (MCI; N = 89) based on comprehensive neuropsychological assessment; MCI group was diagnosed according to core clinical criteria for MCI due to Alzheimer's disease. A control group consisted of 26 cognitively healthy individuals. Participants and their informants completed the MBI-C, evaluating five symptom domains.ResultsBoth self- and informant-rated MBI-C scores were higher in the SCD and MCI groups compared to controls. Informant ratings correlated more strongly with objective cognitive deficit, particularly in memory and executive function domains, whereas self-ratings showed only one association (higher apathy with worse attention). In MCI, informants reported more severe impulse dyscontrol symptoms. Correlations between self and informant ratings were weak to moderate.ConclusionsThis study highlights discrepancies between self- and informant-rated NPS assessments, with informant ratings more strongly linked to cognitive deficits in older adults without dementia. Therefore, we suggest using both assessments to capture informants' and patients' subjective experiences and facilitate early identification of neurodegenerative diseases.