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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 ,
J. E. Gaugler ,
D. P. Devanand ,
N. Scarmeas ,
C. W. Zhu  and
Y. Stern
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
*
Correspondence should be addressed to: K. A. Ornstein, Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA. Phone: 212-659-5555; Fax: 212-849-2566. Email: katherine.ornstein@mssm.edu.
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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.

Keywords

dementia caregivingBPSDbehavioral symptoms
Type
Research Article
Information
International Psychogeriatrics , Volume 25 , Issue 9 , September 2013 , pp. 1453 - 1462
Copyright
Copyright © International Psychogeriatric Association 2013 

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