Caregiver-Care Recipient Relationship Closeness is Associated With Neuropsychiatric Symptoms in Dementia

• Published in: The American journal of geriatric psychiatry 2019-04, Vol.27 (4), p.349-359
• Main Authors: Vernon, Elizabeth K., Cooley, Bryce, Rozum, William, Rattinger, Gail B., Behrens, Stephanie, Matyi, Joshua, Fauth, Elizabeth, Lyketsos, Constantine G., Tschanz, JoAnn T.
• Format: Article
• Language: English
• Subjects: Activities of daily living; Alzheimer disease; caregiver and care recipient; Caregivers; Dementia; neuropsychiatric symptoms; Nurse patient relationships; relationship closeness
• ISSN: 1064-7481; 1545-7214
• DOI: 10.1016/j.jagp.2018.11.010

•This manuscript aims to examine whether closer caregiver-care-recipient relationships are associated with less severe neuropsychiatric symptoms in persons with dementia.•In a sample of community based older adults with dementia and their caregivers, those with reported closer relationships had smaller increases in neuropsychiatric symptom severity over time and that higher reported caregiver-care recipient relationship was associated with lower affective symptoms and change in agitation/aggression and psychotic over time.•This suggests that closer caregiver-care recipient relationships may be a modifiable factor that could be the target of intervention for reducing neuropsychiatric symptoms. Closer caregiver-care recipient (CG-CR) relationships are associated with better cognitive and functional abilities, activities of daily living (in persons with dementia), and lower informal care costs. Due to the difficulty in treating neuropsychiatric symptoms (NPSs) and their detrimental effects on caregivers and care recipients, we examined whether closeness of CG-CR relationships was associated with overall NPS severity or with specific NPS symptom domains in care recipients. In a longitudinal population-based study in Cache County, Utah, the 12-item Neuropsychiatric Inventory (NPI-12) was assessed in 300 CG-CR dyads. Caregivers reported current relationship closeness using the Whitlatch Relationship Closeness Scale. Linear mixed models examined associations between CG-CR closeness and NPI-12 total score or selected symptom domains over time (observation period: 2002–2012). In unadjusted linear mixed models, higher closeness scores were associated with a five-point lower NPI-12 score and a one-point lesser increase in NPI-12 per year. NPI scores also showed lower affective cluster scores (two points) and lesser increase in psychosis cluster (approximately 0.5 points per year) and agitation/aggression (0.16 points per year) for each unit increase in closeness. When controlling for NPI caregiver distress, associations between closeness and NPSs diminished to a 0.5-point lesser increase in total NPI-12 score per year. Adjusted models for NPI domains/clusters showed −0.32 points per year for the psychosis cluster, −0.11 points per year for agitation/aggression, and −0.67 overall for the affective cluster. Higher CG-CR closeness, a potentially modifiable factor, is associated with lower NPS severity and may provide a target for intervention.