Network analysis of neuropsychiatric symptoms in mild behavioral impairment among nursing homes: an observational study

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BACKGROUND: Mild behavioral impairment (MBI) is considered a high-risk factor for dementia, characterized by emergent and sustained neuropsychiatric symptoms (NPS). This study examined the complex co-occurring symptoms and symptom clusters of NPS in older adults with MBI. METHODS: Using a cross-sectional study design, 328 older adults with MBI, defined as the later-life emergence of sustained neuropsychiatric symptoms lasting at least 6 months, were recruited in 42 nursing homes in China. Participants’ demographic characteristics were collected using a self-designed questionnaire. The Chinese version of the MBI Checklist (MBI-C) was used to assess the degree and severity of NPS. The collected data were used for network analysis to identify the core symptom and bridge symptoms in the MBI network by calculating the strength centrality and bridge centrality. Additionally, symptoms most strongly connected to bridge symptoms were examined to explore potential comorbid mechanisms. RESULTS: Eighteen symptoms forming three clusters were included in this study. Network analysis revealed that the NPS “Not experiencing pleasure” had the highest centrality strength (rs=5.734), with the top three bridge strengths being “Not experiencing pleasure” (rBS=2.644), “Diminished and defeated” (rBS=2.484), and “More stubborn or rigid” (rBS=2.269). “Not experiencing pleasure” and “Diminished and defeated” were the bridge symptoms connecting decreased motivation and affective dysregulation clusters, while “More stubborn or rigid” connected affective dysregulation and impulse dyscontrol symptom clusters. CONCLUSIONS: Decreased motivation, affective dysregulation, and impulse dyscontrol in older adults with MBI are highly comorbid and mutually reinforcing. “Not experiencing pleasure” yielded a higher probability of additional NPS. Interventions targeting these symptoms may improve the efficacy of MBI management.

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