Identification of the central symptoms of neuropsychiatric symptoms among older adults with mild cognitive impairment: a network analysis

Background Neuropsychiatric symptoms (NPSs) are prevalent among older adults with mild cognitive impairment (MCI) and are associated with accelerated dementia progression and increased caregiving burden. However, existing studies have mostly focused on total scores or symptom severity, with no study to date using network analysis to identify central symptoms within NPS in older adults with MCI. Design A cross-sectional study was conducted from September 2025 to January 2026 in China. Settings and participants Older adults with MCI in China were recruited. Methods NPSs were evaluated using the Neuropsychiatric Inventory Questionnaire (NPI-Q). Symptom networks were estimated in R using the q-graph and IsingFit packages. Centrality indices including strength, betweenness, closeness, and expected influence, were computed to identify the central symptoms in the NPS network among older adults with MCI. Results A total of 617 older adults with MCI were recruited, of whom 559 were included in the final analysis. Among these participants, 385 (68.9%) were identified as having at least one NPS. The sample comprised 261 females (46.7%), with a median age of 70.0 years. Centrality analyses indicates that disinhibition, irritability/lability, and agitation/aggression had the highest strength and expected influence values, suggesting that these symptoms were the most central symptoms within the NPS network. Conclusion This study primarily provided network analysis to construct a symptom network of NPSs among older adults with MCI. The findings revealed that disinhibition, irritability/lability, and agitation/aggression occupied relatively central positions in the network. Prioritizing the assessment and intervention of these symptoms may help inform more focused and efficient approaches to NPSs management in MCI. Patient or public contribution No patient or public contribution was involved in this study.