Neuropsychiatric symptoms associated with family caregiver burden and depression

Delfino, Lais Lopes; Komatsu, Ricardo Shoiti; Komatsu, Caroline; Neri, Anita Liberalesso; Cachioni, Meire

doi:10.1590/1980-57642021dn15-010014

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Dementia & Neuropsychologia

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Original Article • Dement Neuropsychol 15 (1) • Jan-Mar 2021 • https://doi.org/10.1590/1980-57642021dn15-010014 copy

Neuropsychiatric symptoms associated with family caregiver burden and depression

SINTOMAS NEUROPSIQUIÁTRICOS ASSOCIADOS À SOBRECARGA E DEPRESSÃO DO CUIDADOR FAMILIAR

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Alzheimer's disease (AD) is a progressive and degenerative condition affecting several cognitive areas, with a decline in functional abilities and behavioral changes.

Objective:

To investigate the association between neuropsychiatric symptoms in older adults with AD and caregiver burden and depression.

Methods:

A total of 134 family caregivers of older people diagnosed with AD answered a questionnaire with sociodemographic data and questions concerning the care context, neuropsychiatric symptoms, caregiver burden, and depressive symptoms.

Results:

Results revealed that 95% of older adults had at least one neuropsychiatric symptom, with the most common being: apathy, anxiety, and depression. Among the 12 neuropsychiatric symptoms investigated, 10 were significantly associated with caregiver burden, while 8 showed significant correlations with depressive symptoms.

Conclusions:

Neuropsychiatric symptoms were related to caregiver burden and depressive symptoms. In addition to the older adult with AD, the caregiver should receive care and guidance from the health team to continue performing quality work.

Keywords:
behavioral symptoms; Alzheimer's disease; depression; caregivers

		Mean (SD) or frequency (%)
Caregiver
	Age	58.24 (12.6)
	Gender (female)	107 (80)
	Schooling (years)	14 (3.9)
Hours spent caring
	5 to 10 hours	64 (47)
	11 to 15 hours	7 (5)
	>16 hours	63 (47)
Lives with patient
	Yes	78 (58)
	No	56 (42)
Work in the profession
	Yes	86 (64)
	No	48 (36)
Income
	1 to 5 MW	16 (12)
	3.5 to 5 MW	37 (28)
	>5 MW	81 (60)
Relationship
	Son/daughter	86 (64)
	Husband/wife	34 (25)
	Brother/sister	5 (4)
	Other relatives	9 (7)
	Burden (ZBI total)	31.46 (10.3)
Burden (ZBI scores)
	≤23	36 (27)
	24 to 26	17 (13)
	≥27	81 (60)
	Distress (NPI-D)	13 (9.07)
	Depressive symptoms (BDI)	6.26 (5.98)
Depressive symptoms (BDI scores)
	0 to 15	122 (91)
	16 to 20	7 (5)
	21 to 29	5 (4)
Patient
	Age	80 (7.9)
	Gender (female)	82 (61)
	Schooling (years)	8 (5.7)
	MMSE	18 (5.9)
Use of psychotropic medication
	Yes	120 (90)
	No	14 (10)
	Diagnosis time (years)	3.3 (3.7)
Neuropsychiatric symptoms (NPI)
	Yes	127 (95)
	No	7 (5)

	n (%)	Mean NPI (SD)	Mean distress (SD)
Apathy	71 (53)	3.40 (3.89)	1.61 (1.63)
Anxiety	65 (49)	2.76 (3.44)	1.40 (1.55)
Dysphoria/depression	57 (42)	2.12 (3.26)	1.21 (1.54)
Delusions	55 (42)	2.10 (3.26)	1.19 (1.56)
Aberrant motor behavior	51 (38)	2.87 (4.40)	1.13 (1.60)
Irritability	49 (36)	2.16 (3.38)	1.18 (1.66)
Nighttime behavior disturbances	49 (36)	2.64 (4.08)	1.12 (1.62)
Agitation/aggression	40 (30)	1.96 (3.64)	0.91 (1.53)
Appetite and eating change	39 (29)	2.20 (3.90)	0.93 (1.52)
Disinhibition	38 (28)	2.10 (3.79)	0.90 (1.49)
Hallucinations	37 (27)	1.37 (2.94)	0.79 (1.41)
Euphoria/elation	6 (5)	0.13 (0.88)	0.04 (0.36)

		Burden (ZBI)			Depression (BDI)
		Mean	SD	p-value	Mean	SD	p-value
Delusions	No	29.14	10.12	0.001	4.77	4.73	0.001
Delusions	Yes	34.78	9.9	0.001	8.4	6.91	0.001
Hallucinations	No	29.63	9.91	<0.001	5.32	5.36	0.004
Hallucinations	Yes	36.24	10.16	<0.001	8.73	6.84	0.004
Agitation/aggression	No	29.04	9.27	<0.001	5.33	5.5	0.003
Agitation/aggression	Yes	37.13	10.73	<0.001	8.45	6.53	0.003
Dysphoria/depression	No	28.74	9.36	<0.001	4.96	5.05	0.004
Dysphoria/depression	Yes	35.12	10.62	<0.001	8.02	6.69	0.004
Anxiety	No	30.74	9.42	0.558	6.12	6.26	0.496
Anxiety	Yes	32.22	11.32	0.558	6.42	5.71	0.496
Euphoria/elation	No	30.93	10.04	0.003	5.99	5.76	0.016
Euphoria/elation	Yes	48.5	5.97	0.003	15	7.07	0.016
Apathy	No	28.89	10.66	0.004	4.98	5.88	0.004
Apathy	Yes	33.73	9.62	0.004	7.39	5.88	0.004
Disinhibition	No	30.06	9.97	0.043	6.07	5.93	0.422
Disinhibition	Yes	34.97	10.67	0.043	6.74	6.16	0.422
Irritability/lability	No	28.81	9.02	<0.001	5.74	5.76	0.174
Irritability/lability	Yes	36.04	11.04	<0.001	7.16	6.3	0.174
Aberrant motor behavior	No	30.12	10.65	0.041	5.41	5.4	0.031
Aberrant motor behavior	Yes	33.63	9.62	0.041	7.65	6.64	0.031
Nighttime behavior disturbances	No	29.4	9.79	0.003	5.48	5.84	0.01
Nighttime behavior disturbances	Yes	35.02	10.48	0.003	7.61	6.02	0.01
Appetite and eating change	No	30.68	9.49	0.203	6.05	6.02	0.434
Appetite and eating change	Yes	33.33	12.19	0.203	6.77	5.91	0.434

	Burden (ZBI)		Depression (BDI)
	r	p-value	r	p-value
Delusions	0.32	0.000	0.28	0.001
Hallucinations	0.31	0.000	0.23	0.008
Agitation/aggression	0.37	<0.0001	0.25	0.003
Dysphoria/depression	0.35	<0.0001	0.22	0.010
Anxiety	0.12	0.231	0.05	0.593
Euphoria/elation	0.26	0.003	0.21	0.016
Apathy	0.23	0.008	0.18	0.04
Disinhibition	0.21	0.016	0.09	0.304
Irritability	0.33	0.000	0.12	0.167
Aberrant motor behavior	0.17	0.048	0.17	0.054
Nighttime behavior disturbances	0.24	0.005	0.23	0.008
Appetite and eating change	0.11	0.211	0.06	0.459
NPSs (total)	0.44	<0.0001	0.32	0.000

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[1] Lais Lopes Delfino. Rua Doze de Março, 788 – 19700-047 - Paraguaçu Paulista SP – Brazil. Email: laisgeronto@gmail.com