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?

• Published in: The American journal of geriatric psychiatry 2013-12, Vol.21 (12), p.1277-1286
• Main Authors: Ornstein, Katherine, Ph.D., M.P.H, Gaugler, Joseph E., Ph.D, Devanand, D.P., M.D, Scarmeas, Nikos, M.D, Zhu, Carolyn, Ph.D, Stern, Yaakov, Ph.D
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aggression - psychology; Alzheimer dementia; Alzheimer Disease - nursing; Alzheimer Disease - psychology; BPSD; caregiver depression; Caregivers - psychology; Cohort Studies; Cross-Sectional Studies; Delusions - psychology; Depression - psychology; Female; Humans; Internal Medicine; Lewy Body Disease - nursing; Lewy Body Disease - psychology; Logistic Models; Longitudinal Studies; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Prospective Studies; Quality of Life
• ISSN: 1064-7481; 1545-7214
• DOI: 10.1016/j.jagp.2013.01.062

Objective 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, categorized based on how they may affect caregivers, impact depressive symptoms for dementia patient caregivers and 2) to test the pathways by which BPSD clusters impact caregiver depressive symptoms. Design Cross-sectional analysis of data from a longitudinal study of patients with Alzheimer disease and dementia with Lewy bodies. Setting Multiple U.S. dementia clinics. Participants One hundred sixty patient–caregiver dyads. Methods Using multivariate generalized estimating equation logistic models, we analyzed the relationship between four BPSD clusters (patient depressive symptoms, accusatory/aggressive behaviors, nonthreatening 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 (odds ratio: 1.55; 95% confidence interval: 1.14–2.1). This relationship was mediated by caregiver report of both the symptom's impact on the patient and perceived burden to caregivers. Conclusion 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 and also consider how symptoms may negatively impact caregivers by increasing burden and evoking empathy for the patient.