The Prevalence of Neuropsychiatric Symptoms During Acute Crises in Persons With Dementia-A Systematic Review

Dementia affects millions worldwide, with neuropsychiatric symptoms (NPS) impacting up to 90% of those affected. These symptoms can escalate to crises, which present significant challenges for patients, caregivers, and health care systems.

This study aimed to determine the prevalence of NPS and delirium in patients with dementia during acute crises.

A comprehensive search was conducted across multiple bibliographic databases. Data extraction included NPS such as aggression and hallucinations, NPS measurement tool, delirium diagnoses, delirium screening tool, and discharge locations. Risk of bias was assessed using the Mixed Methods Appraisal Tool (MMAT), and a meta-analysis was performed. The review was reported following PRISMA guidelines.

Nineteen studies published from 1990 to 2023 were included. All were performed in hospitalized patients. Results indicated high heterogeneity in NPS prevalence: on medical wards, aggression 0.47 (95% CI: 0.35-0.59) was the most prevalent, followed by aggression/agitation 0.31 (95% CI: 0.15-0.48). In (gero)psychiatric wards, irritability 0.67 (95% CI: 0.52-0.79), and agitation 0.66 (95% CI: 0.59-0.73) were among the most common symptoms. In addition, 9 studies reported the rate of delirium; the pooled prevalence was 0.24 (95% CI: 0.11-0.38), with studies utilizing a screening tool reporting higher rates.

These findings highlight the prevalence of NPS during crisis hospitalizations and the critical role of deliberate delirium screening. They enhance understanding of dementia crisis phenomenology and offer a foundation for targeted interventions to improve care quality. More research about crises in patients with dementia at home need to be performed.