Caregiver distress associated with behavioral and psychological symptoms in mild Alzheimer's disease

Balieiro Jr., Ari Pedro; Sobreira, Emmanuelle Silva Tavares; Pena, Marina Ceres Silva; Silva-Filho, José Humberto; Vale, Francisco de Assis Carvalho do

doi:10.1590/S1980-57642010DN40300013

Abstract

The aim of this study was to analyze the relationship between Caregiver Distress and Behavioral and Psychological Symptoms in Dementias (BPSD) in mild Alzheimer's disease.

Methods:

Fifty patients and caregivers were interviewed using the Neuropsychiatric Inventory (NPI).

Results:

96.0% of the patients had at least one BPSD. The mean NPI total score was 19.6 (SD=18.05; range=0-78) whereas the mean Caregiver Distress Index (CDI) total score was 11.5 (SD=10.41; range=0-40). For the individual symptoms, the weighted mean CDI was 2.8 (SD=1.58). All symptom CDI means were higher than 2.0 except for euphoria/elation (m=1.8; SD=1.49). There were correlations between CDI and derived measures (Frequency, Severity, FxS, and Amplitude) for all symptoms, except Disinhibition and Night-time behavior. Correlations ranged between 0.443 and 0.894, with significance at p<0.05.

Conclusions:

All the derived measures, including amplitude, were useful in at least some cases. The data suggests that CDI cannot be inferred from symptom presence or profile. Symptoms should be systematically investigated.

Key words:
caregiver distress; psychological and behavioral symptoms; Alzheimer's disease

Resumo

Analisar as relações entre desgaste do cuidador e Sintomas Comportamentais e Psicológicos nas Demências (SCPD) na doença de Alzheimer leve.

Métodos:

Cinquenta pacientes e cuidadores foram entrevistados com o Inventário Neuro-Psiquiátrico (INP).

Resultados:

96,0% dos pacientes tinham pelo menos um SCPD. A média do escore total do INP foi 19,6 (dp=18,05; amplitude=0-78). A média do índice de desgaste do cuidador (IDC) foi 11,5 (dp=10,41; amplitude=0-40). Para os sintomas individuais, a média ponderada do IDC foi 2,8 (dp=1,58) (escala 0-5). Exceto para euforia/elação (m=1,8; dp=1,49), as médias dos IDC foram maiores do que 2,0. Foram encontradas correlações entre o IDC e medidas derivadas para todos os sintomas, exceto Desinibição e Sono. As correlações variaram entre 0,443 e 0,894 (p<0,05).

Conclusões:

Todas as medidas derivadas foram úteis em algum caso. Os dados sugerem que o IDC não pode ser inferido pela presença ou perfil dos sintomas. Antes, deve ser investigado sistematicamente.

Palavras-chave:
desgaste do cuidador; sintomas comportamentais e psicológicos; doença de Alzheimer

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References

International Psychogeriatric Association. Behavioral and Psychological Symptoms of Dementia (BPSD). Educational Pack - Module 1 to 7. 2002.
Ritchie K, Lovestone S. The Dementias. Lancet 2002;360:1759-1766.
Godinho C, Camozzato A, Kochhann R, Chaves MLF. Caregiver and neuropsychiatric symptoms in Alzheimer's disease. Dement Neuropsychol 2008;2:211-216
Cummings JL, Meg M, Gray K, et al. The Neuropsychiatry Inventory: comprehensive assessment of psychopathology in dementia. Neurology 1994;44:2308-2314.
Shimabukuro J, Awata S, and Matsuoka H. Behavioral and psychological symptoms of dementia characteristic of mild Alzheimer patients. Psychiatry Clin Neurosci 2005;59: 274-279.
Mega MS, Cummings JL, Fiorello T, et al. The spectrum of behavioral changes in Alzheimer's disease. Neurology 1996;46: 130-135
Splleta G, Baldinetti F, Buccione I, et al. Cognition and behaviour are independent and heterogeneous dimensions in Alzheimer's disease. J Neurol 2004;251:688-695.
Hart DJ, Craig D, Compton SA, et al. A retrospective study of the behavioural and psychological symptoms of mid and late phase Alzheimer's disease. Int J Geriatr Psychiatry 2003; 18:1037-1042.
Tan LL, Wong HB, and Allen H. The impact of neuropsychiatric symptoms of dementia on distress in family and professional caregivers in Singapore. Int Psychogeriatr 2005; 17: 253-263.
Craig D, Mirakhur A, Hart DJ, McIlroy SP, Passmore AP. A cross-sectional study of neuropsychiatric symptoms in 435 patients with Alzheimer's disease. Am J Geriatr Psychiatry 2005;13:460-468.
Bandeira DR, Pawlowski J, Gonçalves TR, Hilgert JB, Bozzetti MC, Hugo FN. Psychological distress in Brazilian caregivers of relatives with dementia. Aging Ment Health 2007;11:14-19.
Garrido R, Almeida O. Distúrbios de comportamento em pacientes com demência: impacto sobre a vida do cuidador. Arq Neuropsiquiatr 1999;57:427-434.
Aalten P, de Vugt ME, Jaspers N, Jolles J, Verhey FR. The course of neuropsychiatric symptoms in dementia. Part I: findings from the two year longitudinal Maasbed study. Int J Geriatr Psychiatry 2005;20:523-530.
Aguglia E, Onor ML, Trevisiol M, Negro C, Saina M, Maso E. Stress in the caregivers of Alzheimer's patients: An experimental investigation in Italy. Am J Alzheimers Dis Other Demen 2004;19:248-252.
Thomas P, Lalloué F, Preux PM, et al. Dementia patients caregivers quality of life: the PIXEL study. Int J Geriatr Psychiatry 2006;21:50-56.
Chan DC, Kasper JD, Black BS, Rabins PV. Presence of behavioural and psychological symptoms predicts nursing home placement in community-dwelling elders with cognitive impairment in univariate but not multivariate analysis. J Gerontol A Biol Sci Med Sci 2003;58:548-554.
Aarsland D, Brønnick K, Ehrt U, et al. Neuropsychiatric symptoms in patients with Parkinson's disease and dementia: frequency, profile and associated care giver stress. Neurol Neurosurg Psychiatry. 2007;78:36-42.
Jönsson L, Eriksdotter Jönhagen M, Kilander L, et al. Determinants of costs of care for patients with Alzheimer's disease. Int J Geriatr Psychiatry 2006;21:449-459.
Murman DL, Chen Q, Powell MC, Kuo SB, Bradley CJ, Colenda CC. The incremental direct costs associated with behavioral symptoms in AD. Neurology 2002;59:1721-1729.
Glozman J. Quality of life of caregivers. Neuropsychol Rev 2004;14:183-196.
Serrano-Aguilar PG, Lopez-Bastida J, Yanes-Lopez V. Impact on health-related quality of life and perceived burden of informal caregivers of individuals with Alzheimer's disease. Neuroepidemiology 2006;27:136-142.
Chow TW, Liu CK, Fuh JL, et al. Neuropsychiatric symptoms of Alzheimer's disease differ in Chinese and American patients. Int J Geriatr Psychiatry 2002;17:22-28.
Fuh JL, Lam L, Hirono N, Senanarong V, Cummings JL. Neuropsychiatric inventory workshop: behavioral and psychologic symptoms of dementia in asia. Alzheimer Dis Assoc Disord 2006;20:314-317.
Pang FC, Chow TW, Cummings JL, et al. Effect of neuropsychiatric symptoms of Alzheimer's disease on Chinese and American caregivers. Int J Geriatr Psychiatry , 2002;17:29-34.
Cummings JL. The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology 1997;48(5 Suppl 6): S10-S16.
Hughes CP, Berg L, Danziger WL, et al. A new clinical scale for the staging of dementia. Br J Psychiatry 1982;140:566-572.
Morris J. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 1993;43:2412-2414.
Cummings JL, McPherson S. Neuropsychiatric assessment of Alzheimer's disease and related dementias. Aging (Milano) 2001;13:240-246.
Aalten P, de Vugt ME, Jaspers N, Jolles J, Verhey FR. The course of neuropsychiatric symptoms in dementia. Part II: relationships among behavioural sub-syndromes and the influence of clinical variables. Int J Geriatr Psychiatry 2005;20:531-536.
Vale FAC, Mirnada SJC. Clinical and demographic features of patients with dementia attended in a tertiary outpatient clinic. Arq Neuropsiquiatr 2002;60:548-552.
Ballard CG, Margallo-Lana M, Fossey J, et al. A one-year follow-up study of behavioural and psychological symptoms in dementia among people in care environments. J Clin Psychiatry 2001;62:631-636.
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.
Steinberg M, Sheppard JM, Tschanz JT, et al. The incidence of mental and behavioral disturbances in dementia: the cache county study. J Neuropsychiatry Clin Neurosci 2003;15:340-345.
Aalten P, de Vugt ME, Lousberg R, et al. Behavioral problems in dementia: a factor analysis of the neuropsychiatric inventory. Dement Geriatr Cogn Disord 2003;15:99-105.
Steinberg M, Tschanz JT, Corcoran C, et al. The persistence of neuropsychiatric symptoms in dementia: the Cache County Study. Int J Geriatr Psychiatry 2004;19:19-26.
Lyketsos CG, Sheppard JM, Steinberg M, et al. Neuropsychiatric disturbance in Alzheimer's disease clusters into three groups: the Cache County study. Int J Geriatr Psychiatry 2001;16:1043-1053.
Bandeira DR, Pawlowski J, Gonçalves TR, Hilgert JB, Bozzetti MC, Hugo FN. Psychological distress in Brazilian caregivers of relatives with dementia. Aging Ment Health . 2007;11:14-19.
Garrido R and Almeida O. Distúrbios de comportamento em pacientes com demência: impacto sobre a vida do cuidador. Arq Neuropsiquiatr 1999;57:427-434.

Publication Dates

Publication in this collection
Jul-Sep 2010

History

Received
25 May 2010
Accepted
12 July 2010

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

[1] International Psychogeriatric Association. Behavioral and Psychological Symptoms of Dementia (BPSD). Educational Pack - Module 1 to 7. 2002.

[2] Ritchie K, Lovestone S. The Dementias. Lancet 2002;360:1759-1766.

[3] Godinho C, Camozzato A, Kochhann R, Chaves MLF. Caregiver and neuropsychiatric symptoms in Alzheimer's disease. Dement Neuropsychol 2008;2:211-216

[4] Cummings JL, Meg M, Gray K, et al. The Neuropsychiatry Inventory: comprehensive assessment of psychopathology in dementia. Neurology 1994;44:2308-2314.

[5] Shimabukuro J, Awata S, and Matsuoka H. Behavioral and psychological symptoms of dementia characteristic of mild Alzheimer patients. Psychiatry Clin Neurosci 2005;59: 274-279.

[6] Mega MS, Cummings JL, Fiorello T, et al. The spectrum of behavioral changes in Alzheimer's disease. Neurology 1996;46: 130-135

[7] Splleta G, Baldinetti F, Buccione I, et al. Cognition and behaviour are independent and heterogeneous dimensions in Alzheimer's disease. J Neurol 2004;251:688-695.

[8] Hart DJ, Craig D, Compton SA, et al. A retrospective study of the behavioural and psychological symptoms of mid and late phase Alzheimer's disease. Int J Geriatr Psychiatry 2003; 18:1037-1042.

[9] Tan LL, Wong HB, and Allen H. The impact of neuropsychiatric symptoms of dementia on distress in family and professional caregivers in Singapore. Int Psychogeriatr 2005; 17: 253-263.

[10] Craig D, Mirakhur A, Hart DJ, McIlroy SP, Passmore AP. A cross-sectional study of neuropsychiatric symptoms in 435 patients with Alzheimer's disease. Am J Geriatr Psychiatry 2005;13:460-468.

[11] Bandeira DR, Pawlowski J, Gonçalves TR, Hilgert JB, Bozzetti MC, Hugo FN. Psychological distress in Brazilian caregivers of relatives with dementia. Aging Ment Health 2007;11:14-19.

[12] Garrido R, Almeida O. Distúrbios de comportamento em pacientes com demência: impacto sobre a vida do cuidador. Arq Neuropsiquiatr 1999;57:427-434.

[13] Aalten P, de Vugt ME, Jaspers N, Jolles J, Verhey FR. The course of neuropsychiatric symptoms in dementia. Part I: findings from the two year longitudinal Maasbed study. Int J Geriatr Psychiatry 2005;20:523-530.

[14] Aguglia E, Onor ML, Trevisiol M, Negro C, Saina M, Maso E. Stress in the caregivers of Alzheimer's patients: An experimental investigation in Italy. Am J Alzheimers Dis Other Demen 2004;19:248-252.

[15] Thomas P, Lalloué F, Preux PM, et al. Dementia patients caregivers quality of life: the PIXEL study. Int J Geriatr Psychiatry 2006;21:50-56.

[16] Chan DC, Kasper JD, Black BS, Rabins PV. Presence of behavioural and psychological symptoms predicts nursing home placement in community-dwelling elders with cognitive impairment in univariate but not multivariate analysis. J Gerontol A Biol Sci Med Sci 2003;58:548-554.

[17] Aarsland D, Brønnick K, Ehrt U, et al. Neuropsychiatric symptoms in patients with Parkinson's disease and dementia: frequency, profile and associated care giver stress. Neurol Neurosurg Psychiatry. 2007;78:36-42.

[18] Jönsson L, Eriksdotter Jönhagen M, Kilander L, et al. Determinants of costs of care for patients with Alzheimer's disease. Int J Geriatr Psychiatry 2006;21:449-459.

[19] Murman DL, Chen Q, Powell MC, Kuo SB, Bradley CJ, Colenda CC. The incremental direct costs associated with behavioral symptoms in AD. Neurology 2002;59:1721-1729.

[20] Glozman J. Quality of life of caregivers. Neuropsychol Rev 2004;14:183-196.

[21] Serrano-Aguilar PG, Lopez-Bastida J, Yanes-Lopez V. Impact on health-related quality of life and perceived burden of informal caregivers of individuals with Alzheimer's disease. Neuroepidemiology 2006;27:136-142.

[22] Chow TW, Liu CK, Fuh JL, et al. Neuropsychiatric symptoms of Alzheimer's disease differ in Chinese and American patients. Int J Geriatr Psychiatry 2002;17:22-28.

[23] Fuh JL, Lam L, Hirono N, Senanarong V, Cummings JL. Neuropsychiatric inventory workshop: behavioral and psychologic symptoms of dementia in asia. Alzheimer Dis Assoc Disord 2006;20:314-317.

[24] Pang FC, Chow TW, Cummings JL, et al. Effect of neuropsychiatric symptoms of Alzheimer's disease on Chinese and American caregivers. Int J Geriatr Psychiatry , 2002;17:29-34.

[25] Cummings JL. The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology 1997;48(5 Suppl 6): S10-S16.

[26] Hughes CP, Berg L, Danziger WL, et al. A new clinical scale for the staging of dementia. Br J Psychiatry 1982;140:566-572.

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

[28] Cummings JL, McPherson S. Neuropsychiatric assessment of Alzheimer's disease and related dementias. Aging (Milano) 2001;13:240-246.

[29] Aalten P, de Vugt ME, Jaspers N, Jolles J, Verhey FR. The course of neuropsychiatric symptoms in dementia. Part II: relationships among behavioural sub-syndromes and the influence of clinical variables. Int J Geriatr Psychiatry 2005;20:531-536.

[30] Vale FAC, Mirnada SJC. Clinical and demographic features of patients with dementia attended in a tertiary outpatient clinic. Arq Neuropsiquiatr 2002;60:548-552.

[31] Ballard CG, Margallo-Lana M, Fossey J, et al. A one-year follow-up study of behavioural and psychological symptoms in dementia among people in care environments. J Clin Psychiatry 2001;62:631-636.

[32] 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.

[33] Steinberg M, Sheppard JM, Tschanz JT, et al. The incidence of mental and behavioral disturbances in dementia: the cache county study. J Neuropsychiatry Clin Neurosci 2003;15:340-345.

[34] Aalten P, de Vugt ME, Lousberg R, et al. Behavioral problems in dementia: a factor analysis of the neuropsychiatric inventory. Dement Geriatr Cogn Disord 2003;15:99-105.

[35] Steinberg M, Tschanz JT, Corcoran C, et al. The persistence of neuropsychiatric symptoms in dementia: the Cache County Study. Int J Geriatr Psychiatry 2004;19:19-26.

[36] Lyketsos CG, Sheppard JM, Steinberg M, et al. Neuropsychiatric disturbance in Alzheimer's disease clusters into three groups: the Cache County study. Int J Geriatr Psychiatry 2001;16:1043-1053.

[37] Bandeira DR, Pawlowski J, Gonçalves TR, Hilgert JB, Bozzetti MC, Hugo FN. Psychological distress in Brazilian caregivers of relatives with dementia. Aging Ment Health . 2007;11:14-19.

[38] Garrido R and Almeida O. Distúrbios de comportamento em pacientes com demência: impacto sobre a vida do cuidador. Arq Neuropsiquiatr 1999;57:427-434.

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