Skip to main content Accessibility help
×
Home

Are there sensitive time periods for dementia caregivers? The occurrence of behavioral and psychological symptoms in the early stages of dementia

Published online by Cambridge University Press:  03 June 2013

K. A. Ornstein
Affiliation:
Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
J. E. Gaugler
Affiliation:
School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
D. P. Devanand
Affiliation:
Division of Geriatric Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons, Columbia University, New York, New York, USA Taub Institute and the Department of Neurology, Columbia University Medical Center, New York, New York, USA
N. Scarmeas
Affiliation:
Taub Institute and the Department of Neurology, Columbia University Medical Center, New York, New York, USA
C. W. Zhu
Affiliation:
Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
Y. Stern
Affiliation:
Taub Institute and the Department of Neurology, Columbia University Medical Center, New York, New York, USA
Corresponding

Abstract

Background:

The behavioral and psychological symptoms associated with dementia (BPSD) can be burdensome to informal/family caregivers, negatively affecting mental health and expediting the institutionalization of patients. Because the dementia patient–caregiver relationship extends over long periods of time, it is useful to examine how BPSD impact caregiver depressive symptoms at varied stages of illness. The goal of this study was to assess the association of BPSD that occur during early stage dementia with subsequent caregiver depressive symptoms.

Methods:

Patients were followed from the early stages of dementia every six months for up to 12 years or until death (n = 160). Caregiver symptoms were assessed on average 4.5 years following patient's early dementia behaviors. A generalized estimating equation (GEE) extension of the logistic regression model was used to determine the association between informal caregiver depressive symptoms and BPSD symptoms that occurred at the earliest stages dementia, including those persistent during the first year of dementia diagnosis.

Results:

BPSD were common in early dementia. None of the individual symptoms observed during the first year of early stage dementia significantly impacted subsequent caregiver depressive symptoms. Only patient agitation/aggression was associated with subsequent caregiver depressive symptoms (OR = 1.76; 95% CI = 1.04–2.97) after controlling for concurrent BPSD, although not in fully adjusted models.

Conclusions:

Persistent agitation/aggression early in dementia diagnosis may be associated with subsequent depressive symptoms in caregivers. Future longitudinal analyses of the dementia caregiving relationship should continue to examine the negative impact of persistent agitation/aggression in the diagnosis of early stage dementia on caregivers.

Type
Research Article
Copyright
Copyright © International Psychogeriatric Association 2013 

Access options

Get access to the full version of this content by using one of the access options below.

References

Alzheimer's Association. (2012). Alzheimer's Disease Facts and Figures. Alzheimer and Dementia, 8, 131168. doi: 10.1016/j.jalz.2012.02.001.CrossRefGoogle Scholar
Aneshensel, C. S., Pearlin, L. I., Mullan, J. T., Zarit, S. H. and Whitlach, C. J. (1995). Profiles in Caregiving: The Unexpected Career. San Diego, CA: Academic Press.Google Scholar
Anthony-Bergstone, C. R. and Zarit, S. A. (1988). Symptoms of psychological distress among caregivers of dementia patients. Psychology and Aging, 3, 245248.CrossRefGoogle ScholarPubMed
Ballard, C., Corbett, A., Chitramohan, R. and Aarsland, D. (2009). Management of agitation and aggression associated with Alzheimer's disease: controversies and possible solutions. Current Opinions in Psychiatry, 22, 532540.CrossRefGoogle ScholarPubMed
Ben-Shlomo, Y. and Kuh, D. (2002). A life course approach to chronic disease epidemiology: conceptual models, empirical challenges and interdisciplinary perspectives. International Journal of Epidemiology, 31, 285293.CrossRefGoogle ScholarPubMed
Black, W. and Almeida, O. P. (2004). A systematic review of the association between the behavioral and psychological symptoms of dementia and burden of care. International Psychogeriatrics, 16, 295315.CrossRefGoogle ScholarPubMed
Blessed, G., Tomlinson, B. E. and Roth, M. (1968). The association between quantitative measures of dementia and of senile change in the cerebral grey matter of elderly subjects. British Journal of Psychiatry, 114, 797811.CrossRefGoogle ScholarPubMed
Charlson, M. E., Pompei, P., Ales, K. L. and MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Disease, 40, 373383.CrossRefGoogle ScholarPubMed
Cottrell, L. S. (1942). The adjustment of the individual to his age and sex roles. American Sociological Review, 7, 617620.CrossRefGoogle Scholar
Covinsky, K. E.et al. (2003). Patient and caregiver characteristics associated with depression in caregivers of patients with dementia. Journal of General Internal Medicine, 18, 10061014.CrossRefGoogle ScholarPubMed
Derogatis, L. (1993). The Brief Symptom Inventory (BSI): Administration, Scoring and Procedures Manual. Minneapolis, MN: NCS Pearson.Google Scholar
Devanand, D. P.et al. (1992). The Columbia University scale for psychopathology in Alzheimer's disease. Archives of Neurology, 49, 371376.CrossRefGoogle ScholarPubMed
Gaugler, J. E., Davey, A., Pearlin, L. I. and Zarit, S. H. (2000). Modeling caregiver adaptation over time: the longitudinal impact of behavior problems. Psychology and Aging, 15, 437450.CrossRefGoogle ScholarPubMed
Gaugler, J. E., Zarit, S. H. and Pearlin, L. I. (2003). The onset of dementia caregiving and its longitudinal implications. Psychology and Aging, 18, 171180.CrossRefGoogle ScholarPubMed
Gaugler, J. E., Kane, R. L., Kane, R. A. and Newcomer, R. (2005). The longitudinal effects of early behavior problems in the dementia caregiving career. Psychology and Aging, 20, 100116.CrossRefGoogle ScholarPubMed
Gaugler, J. E., Kane, R. L. and Newcomer, R. (2007). Resilience and transitions from dementia caregiving. Journal of Gerontology B Psychological and Social Sciences, 62, 3844.CrossRefGoogle ScholarPubMed
Leggett, A. N., Zarit, S., Taylor, A. and Galvin, J. E. (2011). Stress and burden among caregivers of patients with Lewy body dementia. Gerontologist, 51, 7685. doi: 10.1093/geront/gnq055.CrossRefGoogle ScholarPubMed
Lyketsos, C. G., Lopez, O., Jones, B., Fitzpatrick, A. L., Breitner, J. and DeKosky, S. (2002). Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the cardiovascular health study. JAMA, 288, 14751483.CrossRefGoogle ScholarPubMed
Marcus, R., Marder, K., Bell, K., Dooneief, G., Mayeux, R. and Stern, Y. (1991). Interrater reliability of extrapyramidal signs in a group assessed for dementia. Archives of Neurology, 48, 11471149.Google Scholar
McKeith, I.et al. (1996). Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): report of the consortium on DLB international workshop. Neurology, 47, 11131124.CrossRefGoogle Scholar
McKeith, I.et al. (2004). Dementia with Lewy bodies. Lancet Neurology, 3, 1928.CrossRefGoogle ScholarPubMed
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D. and Stadlan, E. M. (1984). Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology, 34, 939944.CrossRefGoogle ScholarPubMed
National Alliance for Caregiving and AARP. (2004). Caregiving in the US. Washington, DC: National Alliance for Caregiving and AARP.Google Scholar
Ornstein, K. and Gaugler, J. E. (2012). The problem with “problem behaviors”: a systematic review of the association between individual patient behavioral and psychological symptoms and caregiver depression and burden within the dementia patient-caregiver dyad. International Psychogeriatrics, 24, 15361552. doi: 10.1017/s1041610212000737.CrossRefGoogle ScholarPubMed
Ornstein, K., Gaugler, J. E., Devanand, D. P., Scarmeas, N., Zhu, C. and Stern, Y. (2013). 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? American Journal of Geriatric Psychiatry. doi: 10.1097/JGP.0b013e31826d6b31.CrossRefGoogle ScholarPubMed
Pearlin, L. I., Mullan, J. T., Semple, S. J. and Skaff, M. M. (1990). Caregiving and the stress process: an overview of concepts and their measures. Gerontologist, 30, 583594.CrossRefGoogle ScholarPubMed
Pinquart, M. and Sorensen, S. (2003). Differences between caregivers and noncaregivers in psychological health and physical health: a meta-analysis. Psychology and Aging, 18, 250267.CrossRefGoogle ScholarPubMed
Soto, M. E., Andrieu, S., Gillette-Guyonnet, S., Cantet, C., Nourhashemi, F. and Vellas, B. (2006). Risk factors for functional decline and institutionalisation among community-dwelling older adults with mild to severe Alzheimer's disease: one year of follow-up. Age Ageing, 35, 308310. doi: 10.1093/ageing/afj059.CrossRefGoogle ScholarPubMed
Steinberg, M.et al. (2003). The incidence of mental and behavioral disturbances in dementia: the cache county study. Journal of Neuropsychiatry and Clinical Neurosciences, 15, 340345.CrossRefGoogle ScholarPubMed
Stern, Y., Paulson, J. and Mayeux, R. (1987). Modified mini-mental state examination: validity and reliability. Neurology, 37, 179179.Google Scholar
Stern, Y.et al. (1997). Predicting time to nursing home care and death in individuals with Alzheimer disease. JAMA, 277, 806812.CrossRefGoogle ScholarPubMed

Full text views

Full text views reflects PDF downloads, PDFs sent to Google Drive, Dropbox and Kindle and HTML full text views.

Total number of HTML views: 18
Total number of PDF views: 146 *
View data table for this chart

* Views captured on Cambridge Core between September 2016 - 27th January 2021. This data will be updated every 24 hours.

Hostname: page-component-898fc554b-kxqz4 Total loading time: 0.321 Render date: 2021-01-27T04:38:05.121Z Query parameters: { "hasAccess": "0", "openAccess": "0", "isLogged": "0", "lang": "en" } Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": false, "newCiteModal": false }

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Are there sensitive time periods for dementia caregivers? The occurrence of behavioral and psychological symptoms in the early stages of dementia
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Are there sensitive time periods for dementia caregivers? The occurrence of behavioral and psychological symptoms in the early stages of dementia
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Are there sensitive time periods for dementia caregivers? The occurrence of behavioral and psychological symptoms in the early stages of dementia
Available formats
×
×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *