Sex prevalence in mild behavioral impairment: a systematic review and meta‐analysis

Abstract

AbstractBackgroundMild behavioral impairment (MBI) leverages the risk associated with later‐life emergent and persistent neuropsychiatric symptoms (NPS) to identify a high‐risk group for incident cognitive decline and dementia. While sex differences in NPS prevalence have been reported in Alzheimer’s dementia, these differences have not been well explored in dementia‐free samples. Here, we investigated sex differences in MBI prevalence across normal cognition (NC) and mild cognitive impairment (MCI). We also included rater in the analyses (i.e., self, informant, clinician), given that dementia‐free older adults may self‐report symptoms or attend clinic without an informant.MethodsEMBASE, MEDLINE, PsycINFO, and grey literature were systematically searched for articles mentioning MBI. Retrieved abstracts and full‐text articles were screened by two independent reviewers and included if sex‐specific MBI prevalence was reported. A standardized data extraction sheet was used for demographics, cognitive diagnosis, rater, and MBI prevalence within each sex. A risk of bias assessment was conducted. A random‐effects meta‐analysis calculated the pooled prevalence of MBI in each sex, stratified by cognitive diagnosis (NC, MCI, and combined NC/MCI samples) and symptom rater.ResultA total of 5783 articles (EMBASE n = 2752, MEDLINE n = 1798, PsycINFO n = 1233) were retrieved from the search; 165 full‐texts were screened, and 64 were included for data extraction (Figure 1). In females, MBI prevalence increased as cognitive status declined from NC (25%) to mixed cognition (32%) to MCI (43%) [Table 1]. MBI prevalence was highest when reported by informants (35%), followed by clinicians (23%), and self‐reports (20%) [Table 2]. Similarly, in males, MBI prevalence increased with declining cognition (NC = 27%, NC/MCI = 37%, MCI = 48%). MBI prevalence was highest when reported by informants (40%), followed by self‐reports (23%) and clinicians (22%).ConclusionIn both males and females, approximately a quarter of NC and nearly half of MCI participants had symptoms of MBI; prevalence was slightly greater in males. Informants reported MBI symptoms more than clinicians or participants themselves. These findings suggest that MBI is prevalent in dementia‐free older adults of both sexes and that informants are essential given the increasing MBI prevalence with declining cognition.