Determinants of behavioral and psychological symptoms of dementia: A scoping review of the evidence

Behavioral and psychological symptoms of dementia (BPSD) are prevalent in people with neurodegenerative diseases. 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? 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. 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. Research and policy implications are relevant to the National Plan to Address Alzheimer’s Disease. •Interventions for dementia symptoms rely on identification of their determinants.•Patient, caregiver, and environmental determinants of symptoms are identified.•Little evidence for caregiver and environmental determinants was found.•Research gaps include lack of consistent measures and longitudinal data for symptoms.•Policy implications reflect goals of the National Alzheimer's Project Act.