PROGNOSTIC SIGNIFICANCE OF SPECIFIC NEUROPSYCHIATRIC SYMPTOMS IN VASCULAR DEMENTIA

Over 90 % of patients with vascular dementia (VaD) exhibit neuropsychiatric symptoms (NPS), which significantly burden the course of the disease. However, the role of specific NPS as markers for long-term prognosis remains insufficiently explored. The study aimed to establish the prognostic significance of individual NPS regarding overall survival (OS), recurrence-free survival (RFS), and event-free survival (EFS) in patients with VaD compared to other etiological groups. A total of 121 patients were examined (65 with VaD, 26 with neurodegenerative diseases (NDD), and 30 with mixed dementia (MD)). NPS assessment was performed using the Neuropsychiatric Inventory (NPI) scale. Survival analysis was conducted using the Kaplan-Meier method and Cox’s F-test over a 30-month follow-up period. The impact of NPS on prognosis was found to be specifically dependent on the etiology of dementia. In VaD, delusional symptoms were a statistically significant unfavorable marker for OS (cumulative survival rate 11.6 % vs. 100 % at 18 months, p = 0.021). Sleep disturbances were associated with a higher risk of psychiatric readmissions (RFS: p = 0.021). Anxiety (p = 0.0045) and disinhibition (p = 0.0075) were identified as negative predictors of EFS in VaD. Conversely, depression in VaD demonstrated a paradoxical "protective" effect regarding EFS (p=0.048), contrasting with the NDD group, where depression and delusions were indicators of a poorer prognosis. The study revealed that delusions, sleep disturbances, anxiety, and disinhibition are particularly unfavorable prognostic factors in VaD compared to NDD and MD. Thus, NPS serve as valid prognostic markers. Differentiated assessment of the NPS profile in VaD allows for the identification of high-risk groups for hospitalization and mortality, which is critical for optimizing clinical management strategies.