Work

The Prevalence of Neuropsychiatric Symptoms in Alzheimer's Disease: An Updated Systematic Review and Meta‐Analysis

Year: 2025

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: Background Neuropsychiatric symptoms (NPS) are integral to Alzheimer's disease (AD) yet often go under‐recognized, despite their profound impact on disease progression, patient outcomes, and care strategies. Method A systematic search was conducted in PubMed, EMBASE, SCOPUS, Ovid, and Web of Science up to January 19, 2025. Studies were included if they were original research with a cross‐sectional or longitudinal design, involving patients with probable or possible AD diagnosed according to DSM‐IV or NINCDS‐ADRDA criteria, and reported the prevalence of NPS. The inverse variance method and Freeman‐Tukey double arcsine transformation were used for the proportion analysis. For the odds ratio analysis, the inverse variance method (random effects model) was used with tau^2 estimated by the restricted maximum‐likelihood estimator (RLE) and confidence intervals (CI) via Q‐Profile. Result In our meta‐analysis of neuropsychiatric symptoms in Alzheimer's disease (AD), we analyzed 400 studies with 3,189,267 observations and 306,880 events. The individual symptoms in decreasing order of their proportion were: Apathy (0.4748 [0.3875; 0.5630]), Irritability (0.4120 [0.3612; 0.4636]), Depression/Dysphoria (0.3802 [0.3253; 0.4366]), Agitation (0.3304 [0.2756; 0.3877]), and Anxiety (0.3072 [0.2541; 0.3629]). There was substantial heterogeneity across studies (I^2 = 99.9%). For deriving pooled odds ratios we analyzed 125 studies with a total of 266,938 observations for the odds ratio. None of the individual symptoms had a significant association. Aberrant motor behavior exhibited the highest association with AD (OR = 12.90 [0.63, 262.46]), followed by wandering (OR = 2.70 [0.06, 128.85]), psychosis (OR = 1.81 [0.37, 8.82]), delusions (OR = 1.52 [0.67, 3.44]), and apathy (OR = 1.33 [0.57, 3.12]). Substantial heterogeneity was observed ( I 2 = 97.4%). Conclusion Our meta‐analysis reveals that the most prevalent neuropsychiatric symptoms in Alzheimer's disease are apathy, irritability, and depression/dysphoria, with substantial heterogeneity across studies.

Source: Alzheimer s & Dementia

DOI: 10.1002/alz70857_106948