Abstract
OBJECTIVE: Vascular cognitive impairment (VCI) is a major cause of cognitive decline associated with vascular brain injury. Behavioral and psychological symptoms of dementia (BPSD) are common, but their prevalence across VCI subtypes remains unclear. This study examines the prevalence of BPSD in different VCI subtypes. METHODS: A systematic review and meta-analysis were conducted following PRISMA guidelines. Studies assessing BPSD in patients with VCI were retrieved from PubMed, Embase, and Web of Science. Studies were eligible if they used the Neuropsychiatric Inventory (NPI) to evaluate symptoms. Pooled prevalence rates for each NPI domain were calculated using a random-effects model. RESULTS: Thirty-five studies (n=5,805) were included. In unspecified VCI, apathy (54.29%), depression (43.48%), and irritability (38.76%) were most common. Subcortical VCI was associated with higher apathy (62.01%), depression (52.11%), and irritability (44.73%). Mixed dementia featured increased apathy (61.65%), depression (45.68%), sleep disturbances (44.63%), and more hallucinations (26.64%). VCI non-dementia (VCI-ND) was associated with depression (44.97%), irritability (32.75%), and anxiety (30.07%). CONCLUSION: BPSD are prevalent across VCI subtypes but vary. Mixed dementia features more hallucinations and sleep disturbances, likely due to overlapping vascular and neurodegenerative pathology. Apathy and agitation in subcortical VCI may reflect vascular burden. Further research is warranted to clarify underlying neurobiological mechanisms.