Late-life Onset Psychosis-like Symptoms Assessed in the Mild Behavioral Impairment Framework are Associated Impaired Performance on the Stroop Task

Abstract

Late-life onset psychosis and milder delusion-like ideation are known risk factors for cognitive decline and dementia. The Mild Behavioural Impairment (MBI) framework was developed to capture specific psychotic-like symptoms relevant to dementia prognosis in older adults. This study aims to investigate the cognitive deficits associated with MBI-psychosis and their implications for understanding the underlying mechanisms and potential treatment targets. The study recruited participants between November 2021 and July 2022 from the PROTECT study registry. Participants completed the Cambridge Gambling Task, Stroop, Trail Making, Paired Associates Learning, Verbal Reasoning, Digit Span and Self-Ordered Search. Psychotic symptom status was assessed using the Mild Behavioural Impairment Checklist (MBI-C), with participants categorized as MBI-psychosis if they or their study partner reported any psychotic symptoms. Out of 2,111 eligible participants invited, 417 consented to participate. There were no significant differences in age, sex, education level, or mental health history between the MBI-psychosis and No Psychosis groups. Participants with MBI-psychosis exhibited significantly worse performance on the Stroop task (p=0.0002, Cohen’s d=0.37) compared to those without psychosis. There was also some evidence of impairment in verbal reasoning, though it did not reach significance after Bonferroni correction. No significant differences were found on other cognitive measures. This cross-sectional study provides insight into the cognitive deficits associated with MBI-psychosis. The finding of impaired Stroop task performance in individuals with MBI-psychosis is noteworthy, as this deficit is commonly observed in earlier-life major psychotic disorders. Further research is needed to explore the neural underpinnings of these deficits and to determine whether they represent early markers of neurodegenerative disease or other factors.