Objective: The Neuropsychiatric Inventory- Questionnaire (NPI-Q) is a measure completed by caregivers of patients with dementia assessing for behavioral and psychiatric symptoms. The present study sought to identify cognitive and functional correlates of neuropsychiatric symptoms over time in a sample of patients with mild Alzheimer's disease (AD). Method: Data was utilized from 255 participants with mild AD (Clinical Dementia Rating of 0.5 or 1) who were enrolled in the Baylor College of Medicine Alzheimer's Disease and Memory Disorders Center. Prior factor analysis had yielded two domain scores (Anxiety/Restlessness and Negative/Oppositional) which were used in the current analyses. Mixed effects regression models were used to determine whether total and domain baseline NPI-Q scores were related to rate of cognitive and functional progression, as well as whether changes in neuropsychiatric symptoms over time were related to cognitive and functional progression. Results: Initial Anxiety/Restlessness score was associated with changes on the Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS-Cog) over time. Increases in total NPI-Q score over time were related to worsening ADAS-Cog score, and worsening performance on activities of daily living (ADLs) over time. Change in Anxiety/Restlessness score over time was related to worsening ADAS-Cog and ADL scores. Conclusion: Changes in neuropsychiatric symptoms, particularly those symptoms of Anxiety/Restlessness, over time are related to cognitive and functional decline. This finding highlights the importance of assessing for psychiatric and behavioral changes as well as cognitive changes in AD.