Behavioral and psychological symptoms of dementia associated with vascular impairment: a systematic review and meta-analysis

Braz J Psychiatry. 2025 Jun 10. doi: 10.47626/1516-4446-2025-4225. Online ahead of print.

ABSTRACT

INTRODUCTION: Vascular cognitive impairment (VCI) is a major cause of cognitive decline associated with vascular brain injury. Behavioral and psychological symptoms of dementia (BPSD) are common, but their prevalence across VCI subtypes remains unclear. This study examines the prevalence of BPSD in different VCI subtypes.

METHODS: A systematic review and meta-analysis were conducted following PRISMA guidelines. Studies assessing BPSD in VCI patients were retrieved from PubMed, Embase, and Web of Science. Eligible studies used the Neuropsychiatric Inventory (NPI) to evaluate symptoms. Pooled prevalence rates for each NPI domain were calculated using a random-effects model.

RESULTS: Thirty-five studies with 5,805 patients were included. In unspecified VCI, apathy (54.29%), depression (43.48%), and irritability (38.76%) were most common. Subcortical VCI showed higher apathy (62.01%), depression (52.11%), and irritability (44.73%). Mixed dementia had increased apathy (61.65%), depression (45.68%), sleep disturbances (44.63%), and more hallucinations (26.64%). VCI non-dementia (VCI-ND) showed depression (44.97%), irritability (32.75%), and anxiety (30.07%).

CONCLUSION: BPSD are prevalent across VCI subtypes but varies. Mixed dementia presents more hallucinations and sleep disturbances, likely due to overlapping vascular and neurodegenerative pathology. Apathy and agitation in subcortical VCI may reflect vascular burden. Further research is warranted to clarify underlying neurobiological mechanisms.

PMID:41043167 | DOI:10.47626/1516-4446-2025-4225