Table 1.
Characteristics of the included studies.
| Study | Setting | Country | Ethnicity | Sample size (M:F) | Dementia type | Dementia diagnosis | Dementia severity | Mean age (yr) | Disease duration | Assessment of BPSD | Assessed by |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Forsell and Winblad (17) | CS | Sweden | NR | 1,101 including 306 dementia patients (46:260) | NR | DSM-III-R | MMSE: -Without depression: 14.6 -With depression: 12.2 |
Without depression: 86.5 With depression: 87.6 |
NR | 1. DSM-IV (major depression) 2. Comprehensive Psychopathological Rating Scale |
Physicians |
| Klein et al. (18) | CS | US | Multiethnicity (White, etc.) | 638 (212:426) | AD: 345 VD: 99 Other: 194 | DSM-IV | MMSE: 16.6 ± 7.2 | 75.2 ± 10.2 | 4.0 ± 3.0 yr | 1. Wandering behavior in the past 2 weeks 2. DSM-IV glossary definitions. (delusions, hallucinations) 3. DSM-IV criteria (sleep disorders) 4. CSDD (depression) |
Clinicians by interviewing the patient and caregiver |
| Teri et al. (19) | CS | US | Multiethnicity (Caucasian, etc.) | 523 (raw data was not presented for sex ratio) | AD | NINCDS-ADRDA criteria | MMSE: 20.4 ± 4.9 | 73.6 ± 6.9 | NR | 1.21-item behavior checklist (anxiety, depression, other problematic behaviors: present or absent) | Physician by observation of patient and informant |
| Bassiony et al. (20) | CS | US | Multiethnicity (Caucasian, African-American, Hispanic) | 342 (82:260) | AD | NINCDS/ ADRDA criteria |
MMSE: 14.7 ± 7.1 | 77.2 ± 9.1 | 4.5 ± 3.0 yr | 1. DSM-IV (psychotic symptoms in the past 2 weeks) | Experienced geriatric psychiatrists using input from family members, caregivers and primary care physicians |
| Lyketsos et al. (21) | CS | US | NR | 1,002 including 329 dementia patients (123:206) | AD: 214 VD: 62 Other: 53 | DSM-IV | CDR 0.5, 1.0, 2, 3–5 | 84.2 ± 7.0 | NR | 1. NPI | Trained psychometrician or nurse |
| Lyketsos et al. (22) | LS | US | Multiethnicity (White and Black) | 842 including 362 dementia patients (132:230) | AD: 258 VD: 86 PD: 6 Other: 12 | DSM-IV, NINCDS/ ADRDA criteria |
NR | 77 ± 5.0 | NR | 1. NPI | Researchers by fully structured interview of informant |
| Arbus et al. (23) | CS | France | NR | 578 | AD | NR | Reisberg classification 2 or 3, 4, 5 or 6 | NR | NR | 1. NPI | NR |
| Rolland et al. (24) | CS | France | NR | 571 | AD | NR | MMSE: 10-29 | Without wandering: 77.4 ± 7.1 With wandering: 77.6 ± 6.7 |
Without wandering: 1.1 ± 1.2 yr With wandering: 1.2 ± 1.2 yr | 1. NPI | Based on a structured interview with a caregiver |
| Xie et al. (25) | CS | China | Chinese | 1,540 including 373 dementia patients (223:150) | NR | DSM-IV | CDR 1 or 2 | 79.9 ± 9.8 | NR | 1. NPI | NR |
| Benoit et al. (26) | LS | France | NR | 482 (140:342) | AD | DSM-IV, NINCDS/ ADRDA criteria |
MMSE -Mild group: 23.5 ± 1.7 -Moderate group: 16.9 ± 2.6 |
Mild group: 77.2 ± 6.0 Moderate group:77.3 ± 7.8 |
Mild group: 38.9 ± 26.9 mon Moderate group: 47.4 ± 32.6 mon | 1. NPI | Based on a structured interview with a caregiver |
| Wilson et al. (27) | LS | US | Multiethnicity (African American, etc.) | 407 (134:273) | AD | NINCDS/ ADRDA criteria |
MMSE -With hallucinations: 17.4 ± 4.1 -Without hallucinations: 19.7 ± 4.3 |
With hallucinations: 76.7 ± 6.6 Without hallucinations: 74.5 ± 7.7 |
NR | 1. Questionnaire (hallucinations, delusions) | A structured interview administered by a trained research assistant |
| Peters et al. (28) | CS | Canada | NR | 804 including 576 dementia patients (252:324) | NR | DSM-III | MMSE: 20.7 ± 5.6 | 73.0 ± 8.5 | NR | 1. NPI | NR |
| Rolland et al. (29) | LS | France | NR | 682 | AD | NINCDS/ ADRDA criteria |
MMSE: 20.1 ± 4.5 | 77.4 ± 7 | NR | 1. NPI | NR |
| Benoit et al. (30) | CS | France | NR | 686 | AD | ICD-10, NINCDS/ ADRDA |
MMSE: 20.0 ± 4.23 CDR 0.5, 1, 2, 3 |
77.9 ± 6.8 | No apathy, no depression: 13.42 ± 13.09 mon Only depression: 8.92 ± 9.41 mon Only apathy: 13.51 ± 14.06 mon Both apathy and depression: 14.09 ± 14.82 mon |
1. NPI | NR |
| Orengo et al. (31) | RS | US | Multiethnicity (African American, Hispanic, Caucasian, etc.) | 385 (383:2) | AD: 82 VD: 70 Other: 226 | ICD-9-CM | NR | NR | NR | 1. RAS | Administered during a telephone screen (research staff) |
| Steinberg et al. (32) | LS | US | NR | 408 | AD: 255 VD: 44 Mixed: 27 Other: 82 | Diagnosed in CCSMHA (DSM–III–R, NINCDS/ ADRDA) |
CDR 0.5–1, 2, 3–5 | NR | NR | 1. NPI | Trained examiner, through a structured interview with the caregiver |
| Rao et al. (33) | LS | US | NR | 449 (166:283) | AD: 271 AD + VD: 31 AD + other: 16 VD: 50 Other: 81 | DSM-III-R NINCDS-ADRDA, NINDS-AIREN |
MMSE -With TBI: 21.8 ± 5.9 -Without TBI: 21.3 ± 5.5 |
With TBI: 84.54 ± 5.3 Without TBI: 85.1 ± 6.5 |
MMSE -With TBI: 1.8 ± 1.4 yr -Without TBI: 1.9 ± 1.3 yr |
1. NPI | Administered to caregivers or to persons very familiar with the participants |
| Spalletta et al. (34) | CS | Italy | NR | 1,015 (292:723) | AD | NINCDS/ ADRDA |
MMSE: 2.7 ± 0.1 | 74.6 ± 0.2 | 2.7 ± 0.1 yr | 1. NPI (10-item) | An informant rated. |
| Arbus et al. (35) | LS | France | NR | 686 (198:488) | AD | DSM-IV, NINCDS/ ADRDA |
MMSE -No depression nor antidepressants at baseline: 20.43 ± 4.09 -Depression and/ or antidepressants at baseline: 19.65 ± 4.33 |
No depression nor antidepressants at baseline: 77.71 ± 7.03 Depression and/ or antidepressants at baseline: 77.99 ± 6.67 |
No depression nor antidepressants at baseline: 13.62 ± 13.40 mon Depression and/ or antidepressants at baseline: 12.73 ± 13.38 mon |
1. NPI | Are read to the caregiver |
| Rountree et al. (36) | LS | US | Multiethnicity (White, etc.) | 641 (205:436) | AD | NINCDS/ ADRDA |
MMSE: 19.5 ± 6.64 | 73.0 ± 8.50 | 3.7 ± 2.29 yr | 1. Questionnaire (hallucinations, delusions) | NR |
| Haibo et al. (37) | CS | China | NR | 1,271 | NR | DSM-IV | MMSE: 16.5 ± 6.3 | 80.9 ± 6.3 | NR | 1. NPI | Neuropsychiatrist |
| Andreasen et al. (38) | CS | Peru, Mexico, Venezuela, Puerto Rico, Cuba, India, China and Dominican Republic | NR | 17,031 including 1,612 dementia patients (359:1,251) | AD: 424 VD: 244 DLB: 55 Unspecified: 889 | DSM-IV 10/66 algorithm |
NR | NR | NR | 1. GMS-AGECAT | Employed researcher |
| Sadak et al. (39) | CS | US | Multiethnicity (White, Black, Hispanic, etc.) | 3,768 (1,647:2,121) | AD: 3,338 DLB: 241 Behavioral variant FTD: 189 | NINCDS-ADRDA (AD), Third report of the DLB Consortium (DLB), Consensus (behavioral variant FTD), NINDS-AIREN (VD) | CDR 1, 2, 3+ | 79 ± 6.98 | NR | 1. NPI-Q | Patient and family caregiver self-reports, review of medical records, and clinical evaluations |
| Wergeland et al. (40) | CS | Norway | NR | 1,000 including 415 dementia patients (273:142) | NR | ICD-10 | NR | NR | NR | 1. NPI (10-item) | Physicians |
| Mograbi et al. (41) | CS | Latin America, China, India | NR | 829 | NR | DSM-IV, 10/ 66 criteria |
CDR 0.5, 1, 2/ 3 |
NR | NR | 1. NPI 2. ICD (depression) |
Interview made with an informant |
| Vaingankar et al. (42) | CS | Singapore | Multiethnicity (Chinese, Malay, Indian) | 399 (124:275) | Dementia | Semi-structured GMS-AGECAT along with CSI-D, CERAD test battery, and HAS-DDS, and also by applying the 10/66 protocol's diagnostic criteria |
CDR: 2.2 ± 0.6 | 80.2 ± 0.3 | NR | 1. NPI | Trained lay interviewers to the older adults' informant |
| Connors et al. (43) | LS | Australia | NR | 445 (222:223) | AD | DSM-IV | MMSE: 21.1 ± 5.3 | 78.7 ± 7.3 | 1.6 ± 1.9 yr | 1. NPI (12-item) | A research nurse/ psychologist or specialist clinician |
| Costa et al. (44) | CS | European (England, Estonia, Finland, France, Germany, Netherlands, Spain, Sweden) | NR | 1,997 including 1,217 community patients | AD, VD, Other (raw data was not presented) | Diagnosed by expert assessment (i.e, psychiatrist, neurologist, geriatrician, or general practitioner depending on countries' specific diagnostic procedures) and recorded in the medical record, MMSE score of 24 or below, and the presence of an informal caregiver (who visits at least twice a month) | NR | Agitation (+): 82.02 ± 0.22 Agitation (–): 82.88 ± 0.36 |
NR | 1. NPI | As a structured interview with a knowledgeable informant |
| Lessing et al. (45) | Baseline data from two clinical trials | US | Multiethnicity (White, African-American, etc.) | 509 | Dementia | Physician diagnosis of dementia or MMSE scores of 23 or less | NR | 82.6 ± 8.5 | NR | 1. ABID (aggression, agitation, rejection) | Caregiver-based rating |
| Holmstrand et al. (46) | LS | European (Finland, France, Germany, Netherlands, Spain, etc.) | NR | 1,163 (431:732) | AD: 629 AD+VD: 71 VD: 186 FTD: 6 DLB: 23 Not specified: 185 Other: 54 | NR | MMSE: median 15 | With suicidal ideation: median 82 Without suicidal ideation: median 83 |
NR | 1. NPI-Q 2. CSDD |
Professionals in health or social care or by medical/ nursing/ social care students with practical experience and at least a Bachelor's degree |
ABID, Agitated Behavior in Dementia Scale; AD, Alzheimer's disease; BPSD, behavioral and psychological symptoms of dementia; CCSMHA, Cache County Study of Memory Health and Aging; CDR, clinical dementia rating; CERAD, Consortium to Establish a Registry for Alzheimer's Disease; CS, cross-sectional study; CSDD, Cornell Scale for Depression in Dementia; CSI-D, Community Screening Interview for Dementia; DLB, dementia with Lewy bodies; DSM, Diagnostic and Statistical Manual of Mental Disorders; FTD, frontotemporal dementia; GMS-AGECAT, Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy; HAS-DDS, History and Etiology Schedule–Dementia Diagnosis and Subtype; ICD, International Classification of Diseases; LS, longitudinal study; MMSE, Mini-Mental State Examination; NINCDS/ADRDA, National of Neurological Communicative Disease and Stroke and the Alzheimer's Disease and Related Disorders; NPI, neuropsychiatric inventory; NPI-Q, neuropsychiatric inventory-questionnaire; NR, nor recorded; PD, dementia due to Parkinson's disease; RAS, Ryden Aggression Scale; RS, retrospective study; US, United States; VD, vascular dementia.
CDR 0 = absent; 0.5 = questionable; 1 = present, but mild; 2 = moderate; 3 = severe; 4 = profound; and 5 = terminal.