Neuropsychiatric symptoms as the main determinant of caregiver burden in Alzheimer's disease

Kochhann, Renata; Borba, Ericksen; Cerveira, Maria Otília; Onyszko, Diego; Jesus, Alyne de; Forster, Letícia; Franciscatto, Luisa; Godinho, Cláudia; Camozzato, Ana Luiza; Chaves, Márcia Lorena F.

doi:10.1590/S1980-57642011DN05030008

Abstract

Caregiver burden is common in Alzheimer's disease (AD), decreasing the quality of life among caregivers and patients. Projections of aging and aging-related diseases such as AD in developing countries justify additional data about this issue because people living in these countries have shown similarly high levels of caregiver strain as in the developed world.

Objective:

The aim of this study was to analyze the association of AD caregivers' burden with patients' neuropsychiatric symptoms (NPS), cognitive status, severity of dementia, functional capacity, caregiver sociodemographic characteristics, and the characteristics of care provided by caregivers.

Methods:

A cross-sectional study was conducted in a sample of 39 consecutive AD patients and their primary caregivers. NPS were evaluated using the Neuropsychiatric Inventory (NPI). Severity of dementia was assessed with the Clinical Dementia Rating (CDR) scale. Functional capacity was assessed using the Katz and Lawton scales. The burden level was rated using the Burden Interview (BI). Sociodemographic characteristics of caregivers and the characteristics of care provided by them were evaluated. The Mann-Whitney U-test, Kruskal-Wallis test and Spearman's rho coefficient were performed.

Results:

The BI had a moderate correlation with NPI intensity (rho=0.563), p<001. Female caregivers reported a greater level of burden (p=0.031) than male caregivers. The other variables were not significantly associated to caregiver burden.

Conclusion:

NPS were the main determinant of burden in primary caregivers of AD patients. This result underscores the need for prevention and treatment of these symptoms. Sex also had an effect on caregiver burden, but the small male sample in this study precludes the generalization of this finding.

Key words:
neuropsychiatric symptoms; caregiver burden; Alzheimer's disease patients

Resumo

Sobrecarga no cuidador é comum na doença de Alzheimer (DA), diminuindo a qualidade de vida dos cuidadores e pacientes. As projeções de envelhecimento e doenças relacionadas ao envelhecimento como a DA nos países em desenvolvimento justificam dados adicionais sobre esta questão, porque as pessoas que vivem nestes países têm apresentado níveis semelhantes de sobrecarga no cuidador tão alto quanto no mundo desenvolvido.

Objetivo:

O estudo teve como objetivo analisar a associação da sobrecarga em cuidadores de pacientes com DA com sintomas neuropsiquiátricos (NPS) dos pacientes, estatus cognitivo, gravidade da demência, capacidade funcional, características sociodemográficas do cuidador e as características dos cuidados prestados pelos cuidadores.

Métodos:

Um estudo transversal foi realizado em uma amostra de 39 pacientes consecutivos de DA e seus cuidadores primários. NPS foram avaliados através do Inventário Neuropsiquiátrico (NPI). A gravidade da demência foi avaliada com a escala Clinical Dementia Rating (CDR). A capacidade funcional foi avaliada com as escalas de Katz e Lawton. O nível de sobrecarga foi avaliada utilizando a escala Burden Interview (BI). Características sociodemográficas dos cuidadores e as características de atendimento prestado por eles foram avaliadas. Mann-Whitney, Kruskal-Wallis e coeficiente rho de Spearman foram calculados.

Resultados:

BI apresentou correlação moderada com a intensidade do NPI (rho=0,563), p<001. Cuidadoras mulheres relataram maior nível de sobrecarga (p=0,031) do que cuidadores do sexo masculino. As demais variáveis não foram significativamente associados à sobrecarga do cuidador.

Conclusão:

NPS foram o principal determinante da sobrecarga do cuidador de pacientes com DA. Esse resultado reforça a necessidade de prevenção e tratamento desses sintomas. Sexo também teve um efeito sobre a sobrecarga do cuidador, mas a pequena amostra do sexo masculino neste estudo evita a generalização dessa constatação.

Palavras-chave:
sintomas neuropsiquiátricos; sobrecarga do cuidador; pacientes com doença de Alzheimer

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References

Rymer S, Salloway S, Norton L, Malloy P, Correia S, Monast D. Impaired awareness, behavior disturbance, and caregiver burden in Alzheimer disease. Alzheimer Dis Assoc Disord 2002; 16:248-253.
Prince M, 10/66 Dementia Research Group. Care arrangements for people with dementia in developing countries. Int J Geriatr Psychiatry 2004;19:170-177.
Godinho C, Camozzato A, Kochhann R, Chaves ML. Association of caregiver demographic variables with neuropsychiatric symptoms in Alzheimer's disease patients for distress on the Neuropsychiatric Inventory (NPI). Dement Neuropsychol 2008;2:211-216.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV 4th ed. Washington, DC: American Psychiatric Association; 1994.
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report from the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 1984;34:939-944.
Folstein MR, Folstein SE, McHugh PR. "Mini-mental State:" a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.
Chaves ML, Izquierdo I. Validity of the Clinical Dementia Rating scale for the detection and staging of dementia in Brazilian patients. Acta Neurol Scand 1992; 85:378-382.
Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para o uso do Mini-Exame do Estado Mental no Brasil. Arq Neuropsiquiatr 2003;61:777-781.
Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA 1963;185:914-919.
Lawton MP, Brody EM. Assessment of older people: Self-maintaining and instrumental activities of daily living. The Gerontologist 1969;9:179-186.
Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL. A new clinical scale for the staging of dementia. Brt J Psychiatry 1982;140:566-572.
Morris JC. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 1993;43:2412-2414.
Chaves ML, Camozzato AL, Godinho C, et al. Validity of the Clinical Dementia Rating scale for the detection and staging of dementia in Brazilian patients. Alzheimer Dis Assoc Disord 2007;21:210-217.
Cummings JL. The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology 1997;48: S10-S16.
Camozzato AL, Kochhann R, Simeoni C, et al. Reliability of the Brazilian Portuguese version of the Neuropsychiatric Inventory (NPI) for patients with Alzheimer's disease and their caregivers. Int Psychogeriatr 2008;20:383-393.
Zarit SH, Orr NK, Zarit JM. The hidden victims of Alzheimer's disease: Families under stress. New York: New York University Press; 1985.
Scazufca M. Brazilian version of the burden interview scale for the assessment of burden of care in carers of people with mental illnesses. Rev Bras Psiquiatr 2002;24:12-17.
Taub A, Andreoli SB, Bertolucci PH. Dementia caregiver burden: reliability of the Brazilian version of the Zarit caregiver burden interview. Cad Saúde Pública 2004;20:372-376.
ABEP - Associação Brasileira de Empresas de Pesquisa - 2008 - http://www.abep.org - Dados com base no Levantamento Sócio Econômico - 2005 - IBOPE.
» http://www.abep.org
Coen RF, Swanwick GR, O'Boyle CA, Coakley D. Behaviour disturbance and other predictors of carer burden in Alzheimer's disease. Int J Geriatr Psychiatry 1997;12:331-336.
Moscoso MA, Marques RCG, Ribeiz SRI, et al. Profile of caregivers of Alzheimer's disease patients attended at a reference center for cognitive disorders. Dement Neuropsychol 2007;1:412-417.
Fialho PPA, Koenig AM, Santos EL, et al. Dementia caregiver burden in a Brazilian sample: association to neuropsychiatric symptoms. Dement Neuropsychol 2009; 3:132-135.
Mohamed S, Rosenheck R, Lyketsos CG, Schneider LS. Caregiver burden in Alzheimer disease: cross-sectional and longitudinal patient correlates. Am J Geriatr Psychiatry 2010;18:917-927.
Lyketsos CG, Lopez O, Jones B, Fitzpatrick AL, Breitner J, DeKosky S. Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: Results from the cardiovascular health study. JAMA 2002;288:1475-1483.
Sink KM, Covinsky KE, Newcomer R, Yaffe K. Ethnic differences in the prevalence and pattern of dementia-related behaviors. J Am Geriatr Soc 2004;52:1277-1283.
Lopez OL, Wisniewski SR, Becker JT, Boller F, DeKosky ST. Psychiatric medication and abnormal behavior as predictors of progression in probable Alzheimer's disease. Arch Neurol 1999;56:1266-1272.
Smith DA, Beier MT. Association between risperidone treatment and cerebrovascular adverse events: examining the evidence and postulating hypotheses for an underlying mechanism. J Am Med Dir Assoc 2004;5:129-132.
Wooltorton E: Risperidone (Risperdal): increased rate of cerebrovascular event in dementia trials. Can Med Assoc 2002; 167:1269-1270.
Livingston G, Johnston K, Katona C, Paton J, Lyketsos CG. Systematic review of psychological approaches to the management of neuropsychiatric symptoms of dementia. Am J Psychiatry 2005;162:1996-2021.

Publication Dates

Publication in this collection
Jul-Sep 2011

History

Received
29 Apr 2011
Accepted
04 July 2011

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] Rymer S, Salloway S, Norton L, Malloy P, Correia S, Monast D. Impaired awareness, behavior disturbance, and caregiver burden in Alzheimer disease. Alzheimer Dis Assoc Disord 2002; 16:248-253.

[2] Prince M, 10/66 Dementia Research Group. Care arrangements for people with dementia in developing countries. Int J Geriatr Psychiatry 2004;19:170-177.

[3] Godinho C, Camozzato A, Kochhann R, Chaves ML. Association of caregiver demographic variables with neuropsychiatric symptoms in Alzheimer's disease patients for distress on the Neuropsychiatric Inventory (NPI). Dement Neuropsychol 2008;2:211-216.

[4] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV 4th ed. Washington, DC: American Psychiatric Association; 1994.

[5] McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report from the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 1984;34:939-944.

[6] Folstein MR, Folstein SE, McHugh PR. "Mini-mental State:" a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.

[7] Chaves ML, Izquierdo I. Validity of the Clinical Dementia Rating scale for the detection and staging of dementia in Brazilian patients. Acta Neurol Scand 1992; 85:378-382.

[8] Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para o uso do Mini-Exame do Estado Mental no Brasil. Arq Neuropsiquiatr 2003;61:777-781.

[9] Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA 1963;185:914-919.

[10] Lawton MP, Brody EM. Assessment of older people: Self-maintaining and instrumental activities of daily living. The Gerontologist 1969;9:179-186.

[11] Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL. A new clinical scale for the staging of dementia. Brt J Psychiatry 1982;140:566-572.

[12] Morris JC. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 1993;43:2412-2414.

[13] Chaves ML, Camozzato AL, Godinho C, et al. Validity of the Clinical Dementia Rating scale for the detection and staging of dementia in Brazilian patients. Alzheimer Dis Assoc Disord 2007;21:210-217.

[14] Cummings JL. The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology 1997;48: S10-S16.

[15] Camozzato AL, Kochhann R, Simeoni C, et al. Reliability of the Brazilian Portuguese version of the Neuropsychiatric Inventory (NPI) for patients with Alzheimer's disease and their caregivers. Int Psychogeriatr 2008;20:383-393.

[16] Zarit SH, Orr NK, Zarit JM. The hidden victims of Alzheimer's disease: Families under stress. New York: New York University Press; 1985.

[17] Scazufca M. Brazilian version of the burden interview scale for the assessment of burden of care in carers of people with mental illnesses. Rev Bras Psiquiatr 2002;24:12-17.

[18] Taub A, Andreoli SB, Bertolucci PH. Dementia caregiver burden: reliability of the Brazilian version of the Zarit caregiver burden interview. Cad Saúde Pública 2004;20:372-376.

[19] ABEP - Associação Brasileira de Empresas de Pesquisa - 2008 - http://www.abep.org - Dados com base no Levantamento Sócio Econômico - 2005 - IBOPE.
» http://www.abep.org

[20] Coen RF, Swanwick GR, O'Boyle CA, Coakley D. Behaviour disturbance and other predictors of carer burden in Alzheimer's disease. Int J Geriatr Psychiatry 1997;12:331-336.

[21] Moscoso MA, Marques RCG, Ribeiz SRI, et al. Profile of caregivers of Alzheimer's disease patients attended at a reference center for cognitive disorders. Dement Neuropsychol 2007;1:412-417.

[22] Fialho PPA, Koenig AM, Santos EL, et al. Dementia caregiver burden in a Brazilian sample: association to neuropsychiatric symptoms. Dement Neuropsychol 2009; 3:132-135.

[23] Mohamed S, Rosenheck R, Lyketsos CG, Schneider LS. Caregiver burden in Alzheimer disease: cross-sectional and longitudinal patient correlates. Am J Geriatr Psychiatry 2010;18:917-927.

[24] Lyketsos CG, Lopez O, Jones B, Fitzpatrick AL, Breitner J, DeKosky S. Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: Results from the cardiovascular health study. JAMA 2002;288:1475-1483.

[25] Sink KM, Covinsky KE, Newcomer R, Yaffe K. Ethnic differences in the prevalence and pattern of dementia-related behaviors. J Am Geriatr Soc 2004;52:1277-1283.

[26] Lopez OL, Wisniewski SR, Becker JT, Boller F, DeKosky ST. Psychiatric medication and abnormal behavior as predictors of progression in probable Alzheimer's disease. Arch Neurol 1999;56:1266-1272.

[27] Smith DA, Beier MT. Association between risperidone treatment and cerebrovascular adverse events: examining the evidence and postulating hypotheses for an underlying mechanism. J Am Med Dir Assoc 2004;5:129-132.

[28] Wooltorton E: Risperidone (Risperdal): increased rate of cerebrovascular event in dementia trials. Can Med Assoc 2002; 167:1269-1270.

[29] Livingston G, Johnston K, Katona C, Paton J, Lyketsos CG. Systematic review of psychological approaches to the management of neuropsychiatric symptoms of dementia. Am J Psychiatry 2005;162:1996-2021.

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