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Prevalence of depression, anxiety, and apathy symptoms across dementia stages: A systematic review and meta-analysis
Leung DKY, Chan WC, Spector A, Wong GHY.. International journal of geriatric psychiatry, 2021-05-04
Topic: Risk, prevention and care in population studies
Objective The present study aimed to resolve inconsistency in reported prevalence of affective symptoms by dementia stage. Methods/design We conducted a meta-analysis of studies with data on dementia stage and prevalence of depression, anxiety, or apathy assessed using validated tools. We performed random-effects meta-analysis and subgroup analysis on symptom prevalence by dementia stage, according to CDR. Results The meta-analysis included 5897 people with dementia from 20 studies. Prevalence rates of depression in mild, moderate, and severe dementia were 38% (95% CI 32%-45%), 41% (95% CI 33%-49%), and 37% (95% CI 17%-56%) respectively. The corresponding prevalence for anxiety was 38% (95% CI 31%-45%), 41% (95% CI 31%-52%), and 37% (95% CI -8%-82%); and 54% (95% CI 45%-62%), 59% (95% CI 44%-73%), and 43% (95% CI 10%-75%) for apathy. The prevalence of depression, anxiety, and apathy did not differ with regard to dementia stage and type. The prevalence of depression in Alzheimer's disease (AD) was significantly lower when it was assessed using diagnostic criteria compared to screening tools. The prevalence of depression in AD was lowest in America, while anxiety in vascular dementia was higher in Europe than Asia. Conclusions Depression, anxiety, and apathy symptoms are highly prevalent across dementia stages. There is no evidence of any changes in prevalence of affective symptom as the illness progresses. Evaluation methods and cultural difference may explain some of the variance, suggesting further investigation of factors that may influence the report of symptoms, such as carer psychosocial characteristics, and more cross-cultural studies are needed.
Key findings
- Results The meta-analysis included 5897 people with dementia from 20 studies.
- The prevalence of depression in Alzheimer's disease (AD) was significantly lower when it was assessed using diagnostic criteria compared to screening tools.
Why it matters
This meta-analysis found that depression, anxiety, and apathy symptoms are common across all stages of dementia, affecting roughly a third to over half of people. It found no evidence that these symptom rates change with dementia stage or type.
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Study details
- Study designmeta-analysis
- Participants5,897
- Evidence strengthHigh
How this study scored 70/100
Published in a peer-reviewed journal, and it is a meta-analysis pooling many studies. Scored zero for effect reported because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (International journal of geriatric psychiatry) |
| Journal's citation record | 2 / 4 | International Journal of Geriatric Psychiatry: journal h-index 190 (OpenAlex, 2026-10-29) |
| Study design | 12 / 12 | A meta-analysis pooling many studies |
| Strength of evidence | 5 / 5 | Rated “high” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 3 / 5 | 2021 — within 6 year(s) of the newest study here |
| Sample size | 3 / 4 | 5,897 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | A review of other studies — randomisation is not credited here |
| Times cited | 5 / 7 | Cited 262 times (OpenAlex, 2026-10-10) |
| Citations per year | 4 / 5 | 37.4 citations a year over 7 year(s) since 2021 |
| Impact for its field and year | 4 / 6 | Cited 9.0× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 2 / 6 | Cited by 8 other studies in this library |
| Still being cited | 3 / 4 | Cited 168 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Gloria Hoi Yan Wong: h-index 34 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | University College London: institution h-index 2,029 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 2 institution(s) in 2 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 33905138) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 70 / 100 | — |
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Read the original
- DOI: 10.1002/gps.5556
- PubMed: 33905138
- Original source →
- Free full text: UCL Discovery (University College London) →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Leung, D. K. Y., Chan, W. C., Spector, A., & Wong, G. H. Y. (2021). Prevalence of depression, anxiety, and apathy symptoms across dementia stages: A systematic review and meta-analysis. International journal of geriatric psychiatry. https://doi.org/10.1002/gps.5556
Vancouver
Leung DKY, Chan WC, Spector A, Wong GHY. Prevalence of depression, anxiety, and apathy symptoms across dementia stages: A systematic review and meta-analysis. International journal of geriatric psychiatry. 2021. doi:10.1002/gps.5556. PMID: 33905138.
BibTeX
@article{leung2021-33905138,
author = {Leung, D. K. Y. and Chan, W. C. and Spector, A. and Wong, G. H. Y.},
title = {{Prevalence of depression, anxiety, and apathy symptoms across dementia stages: A systematic review and meta-analysis}},
journal = {International journal of geriatric psychiatry},
year = {2021},
doi = {10.1002/gps.5556},
pmid = {33905138},
url = {https://doi.org/10.1002/gps.5556}
}
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