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Alzheimer’s caregivers at risk of ’tipping point’ for depression

Rachel Soon
Medical Writer
30 Nov 2017

Caregivers of patients with Alzheimer’s disease and other forms of dementia may be at greater risk of clinical depression once the patient has exceeded a certain number of disease symptoms, say researchers.

In an analysis of 569 community-dwelling patients with dementia and their caregivers in the US, researchers found that the number of behavioural and psychological symptoms of dementia (BPSD) demonstrated by the patients was significantly associated with depression and burden in their respective caregivers, with a total of ≥4 BPSD having strong predictive values for depression (sensitivity 85%, specificity 44%, area under Receiving Operating Characteristic (ROC) curve 0.62, p <0.01), and burden (sensitivity 84%, specificity 43%, area under ROC curve 0.67, p <0.01). [Int Psychogeriatr 2017;16:1–9]

“While BPSD are historically associated with caregiver distress, it is unclear whether there is an identifiable point where BPSD number is associated with heightened caregiver distress,” said the researchers. “The purpose of this study was to determine if such a tipping point exists, to assist clinicians in identifying caregiver compromise.”

Of the 569 pairs of patients involved, 549 (96 percent) displayed at least one BPSD, and had demonstrated an average of 5.7 (SD = 3.06) symptoms within the past month. The analysis was performed across three datasets which included identical demographic, BPSD, cognitive and caregiver well-being measures. The impact of 16 BPSD symptoms on caregiver well-being was measured using linear regression and pre-defined scores for clinically significant distress.

BPSD refer to a heterogenous group of non-cognitive symptoms and behaviours which occur in patients with dementia; these symptoms have been declared as clinically relevant as cognitive symptoms, since they are strongly tied with functional and cognitive impairment. Among the symptoms are agitation, aberrant motor behaviour, anxiety, elation, irritability, depression, apathy, disinhibition, delusions, hallucinations and sleep or appetite changes. [Front Neurol 2012;3:73]

“Caring for persons with four or more BPSD appears to reflect a tipping point for clinically meaningful distress,” wrote the authors. “[These] findings have implications for clinicians working with persons with dementia and their caregivers, and suggest [a] need for continuous monitoring of BPSD and identification of at-risk caregivers.”

In an unrelated study, a systematic review of quality of life (QoL) studies among caregivers of dementia patients found that caregiver QoL was influenced by 10 common factors, comprised of patient/carer demographics; carer–patient relationship; dementia characteristics; demands of caring; carer health; carer emotional well-being; support received; carer independence; carer self-efficacy; and carer’s future concerns. [Alzheimers Dement 2017;13(5):572–581]

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