Neuropsychiatric Symptoms and Caregiver Distress at Diagnostic Assessment for Suspected Memory Disorders: Evidence from the Oxford Brain Health Clinic

Abstract Background Neuropsychiatric symptoms are common in later life, and can be as problematic as cognitive impairment for individuals with memory concerns, yet they are seldom assessed systematically in memory clinics. Early identification of NPS and caregiver distress may inform diagnosis, guide management, and improve outcomes. This study examines the prevalence and correlates of NPS and caregiver distress in a real-world memory clinic cohort at the time of diagnostic assessment. Methods Patients aged ≥ 65 who underwent initial assessment at the Oxford Brain Health Clinic, subsequently attended the memory clinic for diagnosis, and completed the Neuropsychiatric Inventory Questionnaire (NPI-Q) were included. NPS prevalence, co-occurrence, and caregiver distress were described descriptively. Associated factors were analysed using Spearman’s correlations and multivariable linear regression. Results A total of 242 met the inclusion criteria, with a mean age of 77.5 ± 6.3. Of them, 129 received a subsequent diagnosis of dementia, 59 were considered to have mild cognitive impairment (MCI), and 54 had no memory disorder diagnosis. NPS were prevalent (83.5%) in the cohort, generally of mild to moderate severity, with individuals exhibiting a mean of 2.8 symptoms. The no memory disorder and dementia groups showed higher NPS counts than the MCI group (means of 3.1 and 2.9 vs. 2.1). Co-occurrence patterns were complex and depression-centered in the no memory disorder group, limited in MCI, and apathy-centered in dementia. Caregiver distress was also higher in the dementia (mean 15.0) and no memory disorder groups (mean 13.3) than in MCI (mean 10.1). In multivariable analyses, cognitive decline (β = 1.23, p < 0.001) and caregiver distress (β = 0.09, p < 0.001) were independently associated with higher total NPS scores. Diagnostic group also remained significant, with the no memory disorder group exhibiting higher scores than the MCI group (β = − 0.98, p = 0.013). Conclusions NPS and caregiver distress were already common when patients sought diagnostic assessments for memory concerns. Notably, individuals without memory disorders showed preserved cognition but more frequent and complex NPS. These findings highlight the importance of timely recognition of NPS and early caregiver support in diagnostic practice.