The impact of vascular burden on behavioural and psychological symptoms in older adults with dementia: the BEVASDE study

  • Raquel Manso-CalderónEmail author
  • Purificación Cacabelos-Pérez
  • María D. Sevillano-García
  • María E. Herrero-Prieto
  • Rogelio González-Sarmiento
Original Article



Behavioural and psychological symptoms (BPS) worsen quality of life and increase institutionalization in dementia, but the relationship between BPS and vascular burden on neuroimaging is unclear. Our aim is to explore whether the profile of BPS differs between patients with large-vessel or cortical vascular dementia (cVaD), small-vessel or subcortical vascular dementia (sVaD) and Alzheimer’s disease (AD).


The BEVASDE study comprised 806 demented patients (cVaD—136, sVaD—184, AD—486) recruited from outpatient consultations in Salamanca and Avila, Spain. The Clinical Dementia Rating Scale (CDR) and the 12-item Neuropsychiatric Inventory (NPI) were used to evaluate dementia severity and BPS.


BPS were reported in 98.5%, 97.3% and 96.9% of the cVaD, sVaD and AD cases, respectively. The median NPI score was 36 in both cVaD and sVaD and 34 in AD, with a median number of four symptoms per patient. The most frequent disorders were depression (64.4%), apathy (61.8%) and sleep disturbance (60.5%). Multivariate regression analyses after controlling for possible confounders showed a higher risk of euphoria (p = 0.011), apathy (p = 0.007), irritability (p = 0.002) and sleep disturbance (p = 0.020) in cVaD than in AD and more apathy (p = 0.0001) and irritability (p = 0.0001) in sVaD than in AD. In contrast, AD subjects had a higher risk of delusions (p = 0.007) and hallucinations (p = 0.023) than patients with cVaD as well as more aberrant motor behaviour than both cVaD (p = 0.0001) and sVaD (p = 0.003).


BPS are common in dementia and may help in differential diagnosis of the various subtypes. We should inquire about them and treat as necessary.


Behavioural and psychological symptoms Neuropsychiatric inventory Alzheimer disease Vascular dementia Large-vessel Small-vessel 



We gratefully acknowledge the contribution of Centro de Referencia Estatal de Atención a Personas con Enfermedad de Alzheimer y otras Demencias-CREA (Salamanca, Spain), Asociación de familiares de enfermos de Alzheimer-AFA (Avila, Spain) and Centro Residencial Decanos (Avila, Spain) for providing a subset of the AD patients included in this study. The authors also acknowledge the contribution of the Department of Radiology in CAUSA and Complejo Asistencial de Ávila, as well as M. Sánchez-Barba for assistance in the statistical analysis.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The present study was performed in agreement with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The local ethics committee approved the study.

Informed consent

Informed consent was obtained from all individual participants included in the study and/or their relatives and legal guardians.


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Copyright information

© Fondazione Società Italiana di Neurologia 2019

Authors and Affiliations

  1. 1.Department of NeurologyComplejo Asistencial Universitario de Salamanca (CAUSA)SalamancaSpain
  2. 2.Division of Neurology, Department of Internal MedicineComplejo Asistencial de ÁvilaÁvilaSpain
  3. 3.Instituto de Investigación Biomédica de Salamanca (IBSAL)University of SalamancaSalamancaSpain
  4. 4.Department of NeurologyHospital Clínico Universitario de Santiago (CHUS)A CoruñaSpain
  5. 5.Division of Neurology, Department of Internal MedicineHospital El Bierzo de PonferradaLeónSpain
  6. 6.Molecular Medicine Unit, Department of MedicineUniversity of SalamancaSalamancaSpain

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