The Differential Impact of Unique Behavioral and Psychological Symptoms for the Dementia Caregiver: How and Why Do Patients' Individual Symptom Clusters Impact Caregiver Depressive Symptoms?

Abstract

Objectives The behavioral and psychological symptoms associated with dementia (BPSD) are highly burdensome to caregivers. While BPSD consist of a wide variety of patient behaviors including depression, physical aggression and paranoid delusions, it remains unclear whether specific symptoms have a differential impact on caregivers. The aims of this study were (1) to assess how individual BPSD symptoms, categorized based on how they may affect caregivers, impact depressive symptoms for dementia patient caregivers and (2) to test the pathways by which BPSD symptom clusters impact caregiver depressive symptoms. Design Cross-sectional analysis of data from a longitudinal study of patients with Alzheimer’s disease and Dementia with Lewy Bodies. Setting Multiple U.S. dementia clinics. Participants 160 patient-caregiver dyads. Methods Using multivariate GEE logistic models, we analyzed the relationship between four BPSD symptom clusters (patient depressive symptoms, accusatory/aggressive behaviors, non-threatening psychotic symptoms, and difficult to manage behaviors) and caregiver depressive symptoms and assessed mediators of these relationships. Results Only the presence of patient depressive symptoms was associated with caregiver depression (OR=1.55; 95% CI=1.14–2.1). This relationship was mediated by both caregiver report of the symptom’s impact on the patient and perceived burden to caregivers. Conclusions Patient depressive symptoms may be the most important driver of the relationship between BPSD and caregiver depression. Research in this field should further test the effects of individual BPSD symptoms and should also consider how symptoms may negatively impact caregivers by increasing burden and evoking empathy for the patient.

The Heterogeneous Course of Depressive Symptoms for the Dementia Caregiver

“…Mean BSI scores in our sample were 1.4 and previously published mean BSI depression scores for female elderly caregivers is < 1.0 (Anthony-Bergstone, Zarit, & Gatz, 1988). Therefore, based on previous work in our group (Ornstein, Gaugler, Devanand, Scarmeas, Zhu, & Stern, 2012), we used conservative cutpoint BSI score of 2 in order to discern meaningful differences in depressive symptoms among our sample of dementia caregivers. By dichotomizing BSI scores as few to no depressive symptoms (< 2) and depressive symptoms (> = 2), caregivers categorized as having depressive symptoms were (a) one SD above the mean depressive symptom score and (b) indicated that on average each of the six symptoms bothered or impacted them from a minimal to extreme level.…”

Clinical and neurocognitive aspects of hallucinations in Alzheimer’s disease

“…A study has also reported an association between hallucinations and institutionalization in AD [22]. Hallucinations are distressing for both AD patients and caregivers, as shown by studies demonstrating that neuropsychiatric symptoms in the disease are associated with higher rates of stress, depression, and high burden of care in caregivers [39, 40]. Taken together, hallucinations have a number of adverse consequences for patients and caregivers resulting in reduced quality of life, increased caregiver distress, and higher rates of admission to hospital and residential care facilities.…”

Key Neuropsychiatric Symptoms in Common Dementias: Prevalence and Implications for Caregivers, Clinicians, and Health Systems

“…NPS in patients with dementia are more important determinants of caregiver burden and decisions to institutionalize those with dementia than are cognitive symptoms or limitations in everyday function (Berg, Palomäki, Lönnqvist, Lehtihalmes, & Kaste, 2005; Berger et al, 2005; Coen, Swanwick, O'Boyle, & Coakley, 1997; Miyamoto, Ito, Otsuka, & Kurita, 2002; Ornstein et al, 2012; Torti, Gwyther, Reed, Friedman, & Schulman, 2004). Dementia caregivers who experience high burden have high rates of depression (Epstein-Lubow, Davis, Miller, & Tremont, 2008), higher utilization of health services (Draper, Poulos, Cole, Poulos, & Ehrlich, 1992; Kiecolt-Glaser, Dura, Speicher, Trask, & Glaser, 1991; Schubert et al, 2008), higher use of psychotropic medications (Camargos et al, 2012; Pérodeau, Lauzon, Lévesque, & Lachance, 2001), and greater 4-year mortality than noncaregivers (Schulz & Beach, 1999).…”

“…While cognitive impairment is the defining diagnostic feature of all dementias, the clinical presentation frequently includes neuropsychiatric symptoms (NPS)—disturbances in mood, thinking processes, and behavior found in up to 80% of patients with dementia (Jalbert, Daiello, & Lapane, 2008). NPS may be associated with reduced quality of life, accelerated cognitive decline, additional costs of care, institutionalization, and caregiver depression and burden (Berger et al, 2005; Kalapatapu & Neugroschl, 2009; Murman & Colenda, 2005; Ornstein et al, 2012). A few NPS are integral to the diagnostic criteria for specific dementias (e.g., disinhibition, apathy, impulsivity in behavioral variant frontotemporal dementia [bvFTD]; visual hallucinations, nighttime behaviors/sleep disturbances in dementia with Lewy bodies [DLB]).…”