Behavioral and Psychological Symptoms of Dementia as a Clinical Indicator of Disease Severity and Memory Decline in African Populations: Data from the READD–ADSP Project

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BACKGROUND: BPSD are common in persons living with dementia and are often associated with disease severity and caregivers' distress. In Low- and Middle-Income Countries, they are often the symptom complex that compel family to seek medical help. However, the association of BPSD with dementia severity and specific cognitive domains is underexplored in African populations. This study aims to evaluate BPSD among indigenous Africans and the association with specific cognitive domains. METHOD: This cross-sectional study analyzes data collected from nine African countries (Nigeria, Benin, Ghana, Cameroon, Ethiopia, Kenya, Uganda, Tanzania, and Mozambique) participating in the Recruitment and Retention for Alzheimer's Disease Diversity Cohorts in the Alzheimer's Disease Sequencing Project (READD-ADSP) project, from June 2023 to December 2024. Data on neurocognitive factors were collected using the Uniform Data Set (UDS), Neuropsychiatric Inventory Questionnaire (NPI-Q) for BPSD, and the Clinical Dementia Rating (CDR) scale for dementia severity. Data was managed on REDCap and analysis was performed using STATA (v16). Descriptive statistics were employed for symptom prevalence, and Spearman's rank correlation was used to analyze the relationship between NPI-Q and CDR scores. Association between cognitive domains and behavioral symptoms was examined using hierarchical linear model adjusting for covariates such as age, gender, education, and illness duration. RESULT: A total of 641 Africans with dementia (61% female, mean age 76.7±10.1 years) were included. The mean (±SD) NPI and CDR scores were 4.91 (±6.25) and 1.84 (±1.25), respectively. The most prevalent BPSD symptoms were apathy (32%), agitation/aggression (28.7%), and depression (28.1%). Spearman's correlation revealed a weak but significant positive association between NPI-Q severity scores and CDR scores (rho = 0.264, p < 0.001). Behavioral symptoms were significantly associated with dementia severity (β = 1.59, CI: 1.15-2.03) as well as specific cognitive domains, particularly memory (digit span backward: β = -0.38, CI: -0.64 to -0.13). However, the duration of illness was not a significant predictor of behavioral symptoms in this cohort. CONCLUSION: The findings suggest that BPSD are both an indicator and consequence of dementia severity, particularly in memory function. This study posits the need for targeted management of BPSD and improvement in overall patient care in LMICs.