Correlation between neuropsychiatric symptoms and caregiver burden in a population-based sample from São Paulo, Brazil: A preliminary report

Folquitto, Jefferson Cunha; Marques, Rita de Cássia Gomes; Tatsch, Mariana Franciosi; Bottino, Cássio Machado de Campos

doi:10.1590/S1980-57642013DN70300005

ABSTRACT

Neuropsychiatric symptoms and caregiver burden are highly prevalent in older adults with Alzheimer's disease (AD). Objective: To evaluate the correlation between neuropsychiatric symptoms and caregiver burden in a community-based sample from São Paulo, Brazil.

Methods:

A total of 1,563 randomly-selected subjects were assessed by the Mini-Mental State Examination, Fuld Object Memory Evaluation, Informant Questionnaire on Cognitive Decline in the Elderly and Bayer - Activities of Daily Living Scale. Subjects considered screen-positives were submitted to a dementia workup and diagnosis was determined according to ICD-10 criteria. The neuropsychiatric Inventory was applied to caregivers to evaluate neuropsychiatric symptoms and the Zarit Burden Interview was also applied to assess caregivers' burden.

Results:

Sixty-one AD patients, 25 Cognitively Impaired Non Demented (CIND) and 79 healthy elderly subjects were evaluated. Zarit mean scores for controls, CIND and AD were 2.32, 3.92 and 20.11, respectively. There was strong positive correlation between total NPI and Zarit scores.

Conclusion:

In conclusion, neuropsychiatric symptoms showed a significant association with higher rates of caregiver stress.

Key words:
Alzheimer's disease; cognitive impairment no dementia; neuropsychiatric symptoms; caregiver burden.

RESUMO

Sintomas neuropsiquiátricos e sobrecarga do cuidador apresentam alta prevalência em idosos com doença de Alzheimer (DA).

Objetivo:

Avaliar a correlação entre sintomas neuropsiquiátricos e sobrecarga do cuidador em uma amostra comunitária de São Paulo, Brasil.

Métodos:

Um total de 1.563 indivíduos selecionados aleatóriamente foram avaliados através do Mini-Exame do Estado Mental, "Fuld Object Memory Evaluation", "Informant Questionnaire on Cognitive Decline in the Elderly" e da Escala Bayer - Atividades de Vida Diária. Indivíduos considerados suspeitos foram submetidos a uma investigação para demência, sendo o diagnóstico feito com os critérios da CID-10. Inventário Neuropsiquiátrico foi aplicado nos cuidadores para avaliar sintomas neuropsiquiátricos e a Escala Zarit de Sobrecarga no Cuidador para avaliar sobrecarga nos cuidadores.

Resultados:

Sessenta e um pacientes com DA, 25 sujeitos com Comprometimento Cognitivo não Demência (CIND) e 79 idosos saudáveis foram avaliados. A média dos escores da Zarit para controles, CIND e DA foi, respectivamente, 2,32, 3,92 e 20,11 pontos. Houve correlação positiva boa entre os escores da NPI e da Zarit.

Conclusão:

Sintomas neuropsiquiátricos mostraram uma associação significativa com escores mais elevados de estresse do cuidador.

Palavras-chave:
doença de Alzheimer; comprometimento cognitivo não demência; sintomas neuropsiquiátricos; sobrecarga do cuidador.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

REFERENCES

Finkel SI, Silva Jc, Cohen G, et al. Behavioral and psychological signs and symptoms of dementia: a consensus statement on current knowledge and implications for research and treatment. Int Psychogeriatr 1996;8:497-512.
Tatsch MF, Bottino CMC, Azevedo D, et al. Neuropsychiatric Symptoms in Alzheimer Disease and Cognitively Impaired, Nondemented Elderly From a Community-Based Sample in Brazil: Prevalence and Relationship With Dementia Severity. Am J Geriatr Psychiatry 2006;14:438-445.
Lyketsos CG, Corrillo MC, Ryan JM, et al. Neuropsychiatric symptoms in Alzheimer's disease. Alzheimer's Dement 2011;7:532-539.
Vega UM, Marinho V, Engelhardt E, et al. Neuropsychiatric symptoms in dementias: preliminar report of a prospective outpatient evaluation in Brazil. Arq Neuropsiquiatr 2007;65:498-502.
Badia LX, Surinach LN, Gamisans RM. Calidad de vida, tiempo de dedication y carga percebida por el cuidador principal informal del enfermo de Alzheimer. Aten Primaria 2004;34:170-177.
George LK, Gwyther LP. Caregiver well-being a multidimensional examination of family caregivers of demented adults. Gerontology 1986;26: 253-259.
Ryan KA, Weldon A, Persad C, et al. Neuropsychiatric symptoms and executive functioning in patients with mild cognitive impairment: relationship to caregiver burden. Dement Geriatr Cogn Disord 2012;34: 206-215.
Allegri RF, Sarasola D, Serrano CM. Neuropsychiatric symptoms as a predictor of caregiver burden in Alzheimer's disease. Neuropsychiatr Dis Treat 2006;2:105-110.
Folstein MF, Folstein SE, McHugh PR. Mini Mental State: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Research 1975;12:189-198.
Fuld PA, Muramoto O, Blau AD, et al. Cross-cultural and multi-ethnic dementia evaluation by mental status and memory testing. Cortex 1988;24:520-571.
Jorm AF, Korten AE. Assessment of cognitive decline in the elderly by informant interview. Br J Psychiatry 1988;152:209-213.
Lehfeld H, Reisberg B, Finkel S, et al. Informant-rated activities-of-daily-living (ADL): results of a study of 141 items in the USA, Germany, Russia, and Greece from the International ADL Scale Development Project. Alzheimer Dis Assoc Disord 1997;11:39-44
Bustamante SEZ, Bottino CMC, Lopes MA, et al. Instrumentos combinados na avaliação de demência em idosos. Arq Neuropsiquiatr2003; 61:601-606.
Roth M, Tym E, Mountjoy CQ, et al. CAMDEX: a standardised instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia. Br J Psychiatry1986;149: 698-709
Bottino CMC, Almeida OP, Tamai S, et al. Entrevista estruturada para diagnóstico de transtornos mentais em idosos - CAMDEX - The Cambridge examination for mental disorders of the elderly. Brazilian version (translated and adapted on behalf of the editors, Cambridge University Press); 1999.
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 Disord2007;21:210-217.
Cummings JL, Mega M, Gray K, et al. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology 1994;44:2308-2314
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.
Scazufca M. Versão Brasileira da escala Burden Interview para avaliação de sobrecarga em cuidadores de indivíduos com doenças mentais. Rev Bras Psiq 2002;24:12-17.
American Psychiatry Association. Diagnostic ans statistical manual of mental disorders, 4th Edition. Washington, DC. American Psychiatry Association; 1994.
Ebly EM, Hogan DB, Parhad IM. Cognitive impairment in the nondemented elderly. Results from the Canadian Study of Health and Aging. Arch Neurol 1995;52:612-619
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.
Godinho C, Gorczevski I, Heisler A, et al. Clinical and demographic characteristics of elderly patients with dementia assisted at an outpatient clinic in Southern Brazil. Dement Neuropsychol2010;4:42-46.
Lyketsos CG, Lopez O, Jones B, et al. Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the cardiovascular health study. JAMA 2002;288:1475-1483.
Geda YE, Roberts RO, Knopman DS, et al. Prevalence of neuropsychiatric symptoms in mild cognitive impairment and normal cognitive aging: population-based study. Arch Gen Psychiatry 2008;65:1193- 1198.
Fialho PPA, Koenig AM, Santos EL, et al. Dementia caregiver burden in a Brazilian sample: Association to neuropsychiatric symptoms. Dement Neuropsychol2009;3:132-135.
Torti FM, Gwyther LP, Reed SD, et al. A multinational review of recent trends and reports in dementia caregiver burden. Alzheimer Dis Assoc Disord2004;18:99-109.
Gaugler JE, Wall MM, Kane RL, et al. The effects of incident and persistent behavioral problems on change in caregiver burden and nursing home admission of persons with dementia. Med Care 2010;48:875-883.
Bandeira DR, Pawlowski J, Gonçalves TR, et al. Psychological distress in Brazilian caregivers of relatives with dementia. Aging Ment Health 2007;11:14-19.

Publication Dates

Publication in this collection
Jul-Sep 2013

History

Received
08 May 2013
Accepted
04 Aug 2013

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

[1] Finkel SI, Silva Jc, Cohen G, et al. Behavioral and psychological signs and symptoms of dementia: a consensus statement on current knowledge and implications for research and treatment. Int Psychogeriatr 1996;8:497-512.

[2] Tatsch MF, Bottino CMC, Azevedo D, et al. Neuropsychiatric Symptoms in Alzheimer Disease and Cognitively Impaired, Nondemented Elderly From a Community-Based Sample in Brazil: Prevalence and Relationship With Dementia Severity. Am J Geriatr Psychiatry 2006;14:438-445.

[3] Lyketsos CG, Corrillo MC, Ryan JM, et al. Neuropsychiatric symptoms in Alzheimer's disease. Alzheimer's Dement 2011;7:532-539.

[4] Vega UM, Marinho V, Engelhardt E, et al. Neuropsychiatric symptoms in dementias: preliminar report of a prospective outpatient evaluation in Brazil. Arq Neuropsiquiatr 2007;65:498-502.

[5] Badia LX, Surinach LN, Gamisans RM. Calidad de vida, tiempo de dedication y carga percebida por el cuidador principal informal del enfermo de Alzheimer. Aten Primaria 2004;34:170-177.

[6] George LK, Gwyther LP. Caregiver well-being a multidimensional examination of family caregivers of demented adults. Gerontology 1986;26: 253-259.

[7] Ryan KA, Weldon A, Persad C, et al. Neuropsychiatric symptoms and executive functioning in patients with mild cognitive impairment: relationship to caregiver burden. Dement Geriatr Cogn Disord 2012;34: 206-215.

[8] Allegri RF, Sarasola D, Serrano CM. Neuropsychiatric symptoms as a predictor of caregiver burden in Alzheimer's disease. Neuropsychiatr Dis Treat 2006;2:105-110.

[9] Folstein MF, Folstein SE, McHugh PR. Mini Mental State: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Research 1975;12:189-198.

[10] Fuld PA, Muramoto O, Blau AD, et al. Cross-cultural and multi-ethnic dementia evaluation by mental status and memory testing. Cortex 1988;24:520-571.

[11] Jorm AF, Korten AE. Assessment of cognitive decline in the elderly by informant interview. Br J Psychiatry 1988;152:209-213.

[12] Lehfeld H, Reisberg B, Finkel S, et al. Informant-rated activities-of-daily-living (ADL): results of a study of 141 items in the USA, Germany, Russia, and Greece from the International ADL Scale Development Project. Alzheimer Dis Assoc Disord 1997;11:39-44

[13] Bustamante SEZ, Bottino CMC, Lopes MA, et al. Instrumentos combinados na avaliação de demência em idosos. Arq Neuropsiquiatr2003; 61:601-606.

[14] Roth M, Tym E, Mountjoy CQ, et al. CAMDEX: a standardised instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia. Br J Psychiatry1986;149: 698-709

[15] Bottino CMC, Almeida OP, Tamai S, et al. Entrevista estruturada para diagnóstico de transtornos mentais em idosos - CAMDEX - The Cambridge examination for mental disorders of the elderly. Brazilian version (translated and adapted on behalf of the editors, Cambridge University Press); 1999.

[16] 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 Disord2007;21:210-217.

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

[18] 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.

[19] Scazufca M. Versão Brasileira da escala Burden Interview para avaliação de sobrecarga em cuidadores de indivíduos com doenças mentais. Rev Bras Psiq 2002;24:12-17.

[20] American Psychiatry Association. Diagnostic ans statistical manual of mental disorders, 4th Edition. Washington, DC. American Psychiatry Association; 1994.

[21] Ebly EM, Hogan DB, Parhad IM. Cognitive impairment in the nondemented elderly. Results from the Canadian Study of Health and Aging. Arch Neurol 1995;52:612-619

[22] 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.

[23] Godinho C, Gorczevski I, Heisler A, et al. Clinical and demographic characteristics of elderly patients with dementia assisted at an outpatient clinic in Southern Brazil. Dement Neuropsychol2010;4:42-46.

[24] Lyketsos CG, Lopez O, Jones B, et al. Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the cardiovascular health study. JAMA 2002;288:1475-1483.

[25] Geda YE, Roberts RO, Knopman DS, et al. Prevalence of neuropsychiatric symptoms in mild cognitive impairment and normal cognitive aging: population-based study. Arch Gen Psychiatry 2008;65:1193- 1198.

[26] Fialho PPA, Koenig AM, Santos EL, et al. Dementia caregiver burden in a Brazilian sample: Association to neuropsychiatric symptoms. Dement Neuropsychol2009;3:132-135.

[27] Torti FM, Gwyther LP, Reed SD, et al. A multinational review of recent trends and reports in dementia caregiver burden. Alzheimer Dis Assoc Disord2004;18:99-109.

[28] Gaugler JE, Wall MM, Kane RL, et al. The effects of incident and persistent behavioral problems on change in caregiver burden and nursing home admission of persons with dementia. Med Care 2010;48:875-883.

[29] Bandeira DR, Pawlowski J, Gonçalves TR, et al. Psychological distress in Brazilian caregivers of relatives with dementia. Aging Ment Health 2007;11:14-19.

Brasil