International Psychogeriatrics

Behavioral and Psychological Symptoms of Dementia in developing countries

The 10/66 Dementia Research Group 1 , Cleusa P. Ferri c1 and David Ames c2

Article author query
ferri cp   [PubMed][Google Scholar] 
ames d   [PubMed][Google Scholar] 


Background: Little is known about the prevalence of, or associations with behavioral and psychological symptoms of dementia (BPSD) in developing countries.

Methods: Individuals diagnosed as having dementia according to DSM-IV criteria (mild and moderate cases as defined by the Clinical Dementia Rating scale only), together with their main caregiver, were recruited from 21 centers in 17 developing countries. People with dementia were directly assessed with the Community Screening Interview for Dementia and the Geriatric Mental State Schedule (GMS); GMS data were processed by the AGECAT computer program to yield diagnostic information on 8 psychiatric syndromes. Caregivers answered direct questions about behavioral symptoms of dementia (BSD) and completed the Zarit Burden Inventory.

Results: At least one BSD was reported in 70.9% of the 555 participants. At least one case-level AGECAT psychiatric syndrome (not including the organic syndrome) was exhibited by 49.5% of people with dementia. Depression syndromes (43.8%) were most common followed by anxiety neurosis (14.2%) and schizophreniform/paranoid psychosis (10.9%). Caregivers were more likely to report BSD in people with dementia who were married, younger and better educated. More advanced dementia, poorer functioning and the presence of depression or anxiety were each associated with BSD. BSD, and psychiatric syndromes (anxiety neurosis and schizophreniform/paranoid psychosis) predicted caregiver strain after controlling for cognitive impairment. BPSD are poorly understood, leading to shame and blame.

Conclusions: BPSD are common among people with dementia in developing countries, though we found marked regional variations. Representative population studies are needed to clarify prevalence and impact, but our research suggests considerable unmet need, with much scope for intervention. Raising awareness of the problem should be the first step.

(Received November 10 2003)
(returned to authors for revision December 11 2003)
(revised version received January 30 2004)
(Accepted February 4 2004)

Key Words: Dementia; behavioral and psychological symptoms; developing countries; AGECAT.

c1 Correspondence should be addressed to: Dr. Cleusa P. Ferri, Section of Epidemiology, Box 060, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF, U.K. Phone: +44 207 848 0136. Fax: +44 207 277 0283. Email:
c2 Correspondence should be addressed to: A/Prof. David Ames. Department of Psychiatry, Level 7, Charles Connibere Building, Royal Melbourne Hospital, PARKVILLE VIC 3050, Australia. Phone: +61 3 8344 5598. Fax: +61 3 9342 8954 5. Email:


1 The 10/66 Dementia Research Group is a collective of researchers from the developed and developing regions of the world. (See pp. 23–24).