Objective  To systematically evaluate the incidence of behavioral and psychological symptoms of dementia (BPSD) and various symptom types among dementia patients in China.

Methods  A systematic search was conducted in CNKI, WanFang Data, VIP, CBM, PubMed, Web of Science, Embase, the Cochrane Library for relevant literature on BPSD in dementia patients in China from the establishment of the databases to December 6, 2024. Two researchers independently conducted literature screening, data extraction, and quality assessment. Data analysis were performed using Stata 17.0 software.

Results  A total of 39 articles were included, involving 5 695 dementia patients, among whom 3 618 had BPSD. The Meta-analysis results showed that the overall incidence of BPSD in dementia patients in China was 75.7% (95% CI: 69.0%-82.4%). The symptom distribution was scale-dependent. The top five symptoms detected by the Neuropsychiatric Inventory (NPI) were apathy (44.1%), sleep/nighttime behaviors (36.3%), mood instability/irritability (36.1%), depression/mood disturbance (35.3%), and aberrant motor behavior (30.1%). Based on the Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD), the incidence rates of behavioral disturbance (49.9%), circadian rhythm disturbance (49.0%), aggressive behavior (43.0%), and paranoia/delusion (41.4%) were relatively high, all exceeding 40%. Additionally, the incidence rates of emotional disorders (28.8%), anxiety/fear (27.4%), and hallucinations (22.2%) were all over 20%. Subgroup analysis showed that the incidence of BPSD was the highest in mixed dementia (77.0%), significantly higher than that in Alzheimer's disease (72.4%) and vascular dementia (69.6%). The incidence was higher in men (72.1%) than in women (71.1%). The incidence was higher in severe dementia (87.3%) than in moderate (69.0%) and mild (63.7%) dementia. The detection rate by NPI (76.1%) was higher than that by BEHAVE-AD (71.1%).

Conclusion  BPSD is highly prevalent among dementia patients in China. Mixed dementia, male, and severe dementia constitute high-risk subgroups. The symptom spectrum showed significant scale dependence. It is recommended to establish a stratified management pathway based on dementia subtypes and stages, and to construct a multi-dimensional assessment framework to optimize the accuracy of symptom identification.

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