Determinants of behavioral and psychological symptoms of dementia: A scoping review of the evidence
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Background Behavioral and psychological symptoms of dementia (BPSD) are prevalent in people with neurodegenerative diseases.Purpose In this scoping review the Kales, Gitlin and Lykestos framework is used to answer the question: What high quality evidence exists for the patient, caregiver and environmental determinants of five specific BPSD: aggression, agitation, apathy, depression and psychosis?Method An a priori review protocol was developed; 692 of 6013 articles retrieved in the search were deemed eligible for review. Gough's Weight of Evidence Framework and the Cochrane Collaboration's tool for assessing risk of bias were used. The findings from 56 high quality/low bias articles are summarized.Discussion Each symptom had its own set of determinants, but many were common across several symptoms: neurodegeneration, type of dementia, severity of cognitive impairments, and declining functional abilities, and to a lesser extent, caregiver burden and communication.Conclusion Research and policy implications are relevant to the National Plan to Address Alzheimer's Disease.
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NPS are common and persistent non-cognitive dementia symptoms, generally understood to arise from personal, caregiving, and environmental factors.
“Common and persistent non-cognitive symptoms in dementia, NPS are broadly understood to have personal, caregiving, and environmental determinants.8”
From Discharge Communication of Dementia-Related Neuropsychiatric Symptoms and Care Management Strategies during Hospital to Skilled Nursing Facility Transitions (2021) · cites this paper as [8]
The Introduction describes behavioral and psychological symptoms as affecting the vast majority of people with dementia, and the review examines patient, caregiver, and environmental determinants. But persistence is established for particular symptoms, including agitation and aggression, rather than for NPS generally; the Findings summary calls agitation a common and persistent symptom unlike other neuropsychiatric symptoms. The blanket description of NPS as persistent therefore overstates the source. (LLM, conf=0.87)
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The relationship between stress and Alzheimer's disease
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A mouse model of naturally occurring age-related cognitive impairment
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“Common and persistent noncognitive symptoms in dementia, NPS are broadly understood to have personal, caregiving, and environmental determinants.(8) Examples of NPS include agitation, aggression, care resistance, wandering, and apathy.”
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Integrative review: Persistent vocalizations among nursing home residents with dementia
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Self-citationThe fundamentals of a dedicated palliative approach to care for people with dementia
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International Dementia Policies and Legacies of the Coronavirus Disease 2019 Pandemic
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Reliability and Validity of the Knowledge of Person-Centered Behavioral Approaches for BPSD Test
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Self-citationPsychosis associated with dementia: evaluation and management
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Self-citationCaffeine Consumption and Behavioral Symptoms in Nursing Home Residents: A Cross-Sectional Analysis
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- Authors
- Kolanowski, A., Boltz, M., Galik, E., Gitlin, L. N., Kales, H. C., Resnick, B., Van Haitsma, K. S., Knehans, A., Sutterlin, J. E., Sefcik, J. S., Liu, W., Petrovsky, D. V., Massimo, L., Gilmore-Bykovskyi, A., MacAndrew, M., Brewster, G., Nalls, V., Jao, Y.-L., Duffort, N., & Scerpella, D.
- Affiliations
- Pennsylvania State University (US)
- University of Maryland, Baltimore (US)
- Johns Hopkins University (US)
- University of Michigan (US)
- University of Pennsylvania (US)
- University of Iowa (US)
- Queensland University of Technology (AU)
- Corresponding author
- Kolanowski, Ann
- ORCID
- Venue
- Nursing Outlook
- Publisher
- Elsevier BV
- Published
- 2017-09
- Volume
- 65
- Issue
- 5
- Pages
- 515-529
- ISSN
- 0029-6554 (ISSN-L)
- PMC
- PMC6579119
- OpenAlex
- W2625547843
- Cited by
- 165
- References
- 100
- Citations by year
- 2026: 7 · 2025: 14 · 2024: 13 · 2023: 22 · 2022: 27 · 2021: 30 · 2020: 24 · 2019: 14 · 2018: 12 · 2017: 2
- FWCI
- 2.16
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Nursing Outlook (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institute on Aging (K99AG056054)
- National Institute of Nursing Research (F32NR014777)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Keywords
- behavioral and psychological symptoms of dementia, dementia, aggression, agitation, apathy, depression, psychosis, risk factors, neurodegeneration, cognitive impairment severity, functional decline, caregiver burden, communication, Alzheimer's disease
- MeSH terms
- Aged, Aged, 80 and over, Aggression, Alzheimer Disease, Dementia, Depression, Female, Humans, Male, Middle Aged, Psychomotor Agitation, Psychotic Disorders, Apathy
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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