The Mild Behavioral Impairment Checklist (MBI-C): A Rating Scale for Neuropsychiatric Symptoms in Pre-Dementia Populations

Article type: Research Article

Authors: Ismail, Zahinoor^{a; b; *} | Agüera-Ortiz, Luis^c | Brodaty, Henry^d | Cieslak, Alicja^b | Cummings, Jeffrey^e | Fischer, Corinne E.^f | Gauthier, Serge^g | Geda, Yonas E.^h | Herrmann, Nathan^{i; j} | Kanji, Jamila^b | Lanctôt, Krista L.^j | Miller, David S.^k | Mortby, Moyra E.^l | Onyike, Chiadi U.^m | Rosenberg, Paul B.^m | Smith, Eric E.^b | Smith, Gwenn S.ⁿ | Sultzer, David L.^o | Lyketsos, Constantine^p | for the NPS Professional Interest Area of the International Society of to Advance Alzheimer’s Research and Treatment (NPS-PIA of ISTAART)

Affiliations: [a] Department of Psychiatry, and the Mathison Centre for Mental Health Research & Education, Cumming School of Medicine, Calgary, Alberta, Canada | [b] Department of Clinical Neurosciences, and The Ron and Rene Ward Centre for Healthy Brain Aging Research, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada | [c] Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM,Department of Psychiatry & Research Institute i+12, Hospital, Universitario 12 de Octubre, Madrid, Spain | [d] Centre for Healthy Brain Ageing and Dementia Collaborative Research Centre, University of New South Wales, New South Wales, Sydney, Australia | [e] Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA | [f] Keenan Research Centre for Biomedical Research, the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Faculty of Medicine, Department of Psychiatry, University of Toronto, ON, Canada | [g] McGill Centre for Studies in Aging, Douglas Mental Health Research Institute, Montreal, Quebec, Canada | [h] Departments of Psychiatry and Neurology, Mayo Clinic, Scottsdale, AZ, USA | [i] Division of Geriatric Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada | [j] Neuropsychopharmacology Research Program, Sunnybrook Research Institute and Departments of Psychiatry and Pharmacology/Toxicology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada | [k] Bracket Global, Wayne, PA, USA | [l] Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, The Australian National University, NHMRC National Institute for Dementia Research, Canberra, Australia | [m] Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA | [n] Department of Psychiatry and Behavioral Sciences and Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA | [o] Department of Psychiatry and Biobehavioral Sciences, Geffen School of Medicine at UCLA, and the Brain, Behavior, and Aging Research Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA | [p] Memory and Alzheimer’s Treatment Center and Alzheimer’s Disease Research Center, Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview and Johns Hopkins Medicine, Baltimore, MD, USA

Correspondence: [*] Correspondence to: Zahinoor Ismail, MD, TRW Building 1st Floor, 3280 Hospital Dr. NW, Calgary, Alberta, T2N 4Z6, Canada. Tel.: +1 403 210 6900; Fax: +1 403 210 9346; E-mail: [email protected].

Abstract: Background: Mild behavioral impairment (MBI) is a construct that describes the emergence at ≥50 years of age of sustained and impactful neuropsychiatric symptoms (NPS), as a precursor to cognitive decline and dementia. MBI describes NPS of any severity, which are not captured by traditional psychiatric nosology, persist for at least 6 months, and occur in advance of or in concert with mild cognitive impairment. While the detection and description of MBI has been operationalized in the International Society to Advance Alzheimer’s Research and Treatment – Alzheimer’s Association (ISTAART-AA) research diagnostic criteria, there is no instrument that accurately reflects MBI as described. Objective: To develop an instrument based on ISTAART-AA MBI criteria. Methods: Eighteen subject matter experts participated in development using a modified Delphi process. An iterative process ensured items reflected the five MBI domains of 1) decreased motivation; 2) emotional dysregulation; 3) impulse dyscontrol; 4) social inappropriateness; and 5) abnormal perception or thought content. Instrument language was developed a priori to pertain to non-demented functionally independent older adults. Results: We present the Mild Behavioral Impairment Checklist (MBI-C), a 34-item instrument, which can easily be completed by a patient, close informant, or clinician. Conclusion: The MBI-C provides the first measure specifically developed to assess the MBI construct as explicitly described in the criteria. Its utility lies in MBI case detection, and monitoring the emergence of MBI symptoms and domains over time. Studies are required to determine the prognostic value of MBI for dementia development, and for predicting different dementia subtypes.

DOI: 10.3233/JAD-160979

Journal: Journal of Alzheimer's Disease, vol. 56, no. 3, pp. 929-938, 2017