Background: Understanding pathogenetic background and risk factors is the primary step to a better behavioral and psychological symptoms of dementia (BPSD) management. To this aim, this exploratory study is designed to sketch some indicative correlations between BPSD severity and vascular, genetic and cognitive variables.

Methods: A retrospective cross-sectional study conducted on medical reports of 135 Alzheimer Dementia (AD) patients from two memory clinics. Each subject underwent clinical examination and brain Magnetic Resonance Imaging (MRI), mini mental state examination (MMSE) and behavioral assessment using the neuropsychiatric inventory (NPI). This real-world cross-sectional study aimed to correlate the load of white matter lesions and global vascular compromise with clinical assessment. In addition, apolipoprotein E (ApoE) genotype was checked in 92 patients. Data were analysed performing Spearman correlation and principal component analysis (PCA).

Results: BPSD severity was independent from cognitive impairment, vascular impairment, white matter lesions and ApoE status.

Conclusions: Our results do not confirm the possible role for vascular impairment in BPSD severity as previously reported. Studies focusing on different biological features in relation to other structural, psychosocial and environmental factors are needed in order to get a more reliable model.