Association between neuropsychiatric symptoms and neurodegeneration-related plasma biomarkers in older adults with and without clinical dementia in the Democratic Republic of the Congo

Abstract

INTRODUCTION: Neuropsychiatric symptoms (NPS) are prevalent in dementia, but most studies focus on Western populations. This study examines the association between NPS and neurodegeneration-related plasma biomarkers in older adults with and without dementia in the Democratic Republic of the Congo (DRC). METHODS: Eighty-five individuals (≥65 years) underwent dementia adjudication using the Community Screening Instrument for Dementia (CSID) and Alzheimer's Questionnaire (AQ). Plasma biomarkers (amyloid β [Aβ] 42/40, phosphorylated-tau181 [p-tau181], neurofilament light [NfL], glial fibrillary acidic protein (GFAP), interleukin-1β [IL-1β], tumor necrosis factor-α [TNF-α]) were measured. NPS were assessed using the Geriatric Depression Scale (GDS), Beck Anxiety Inventory (BAI), and Neuropsychiatric Inventory Questionnaire (NPI) (for dementia cases). Logistic regressions examined associations between NPS and biomarkers, adjusting for age, sex, and education. RESULTS: NPS were common in dementia cases, with irritability (57.8%) and depression (90.7%) most frequent. GFAP was linked to irritability (odds ratio [OR] = 3.34, p = 0.01), and NfL and GFAP were associated with depressive symptoms (OR = 0.76, p = 0.04; OR = 1.98, p = 0.02, respectively). DISCUSSION: These findings highlight the burden of NPS in the DRC and suggest biomarker-driven mechanisms, emphasizing the need for further research in diverse populations. Highlights: Identifies neuropsychiatric symptoms as early indicators of Alzheimer's disease (AD) progression. Examines associations between depression and AD biomarkers in preclinical and prodromal stages. Highlights the role of amyloid and tau pathology in depression-related cognitive decline. Discusses implications for early intervention and personalized treatment strategies.