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The problem with “problem behaviors”: a systematic review of the association between individual patient behavioral and psychological symptoms and caregiver depression and burden within the dementia patient–caregiver dyad

Published online by Cambridge University Press:  22 May 2012

Katherine Ornstein  and
Joseph E. Gaugler
Katherine Ornstein*
Affiliation:
Mount Sinai Visiting Doctors Program, Mount Sinai Hospital, New York, USA
Joseph E. Gaugler
Affiliation:
School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
*
Correspondence should be addressed to: Katherine Ornstein, PhD, MPH, Director of Research, Mount Sinai Visiting Doctors Program, Mount Sinai Hospital, Box 1216, New York, NY 10029, USA. Phone: +1 212-241-4141; Fax: +1 212-426-5108. Email: [email protected].
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Abstract

Background: Behavioral and psychological symptoms of dementia (BPSDs) are routinely cited as important predictors of caregiver burden and depression. Although BPSDs include a wide variety of patient behaviors, they are routinely grouped together as one construct to differentiate them from cognitive symptoms of dementia. Determining the specific BPSDs that result in increased depression and burden for caregivers may elucidate the stress process for caregivers and facilitate the development of effective interventions for caregivers.

Methods: We conducted a systematic review of English-language articles published from 1990 to 2010 to determine whether there are known symptoms or symptom clusters which exert undue negative impact on caregiver depression and burden. Additionally, we review systems used for classifying BSPD symptom clusters and determine whether there have been any mechanisms studied by which individual BPSD symptoms negatively affect caregivers. Finally, we examine how the role of timing of symptoms has been examined within the literature.

Results: Thirty-five original research articles examined the impact of an individual behavior symptom on caregiver burden or depression/depressive symptoms. The studies had no consistent system for categorizing symptoms. Although depression, aggression, and sleep disturbances were the most frequently identified patient symptoms to impact negatively on caregivers, a wide range of symptoms was associated with caregiver burden and depression.

Conclusions: The evidence is not conclusive as to whether some symptoms are more important than others. The studies reviewed were largely exploratory relative to the differential impact of individual BPSDs and did not focus on testing causal mechanisms by which specific symptoms exert more impact on caregiver mental health than others. Future research may benefit from the re-conceptualization of BPSDs from the perspective of their impact on the caregiver to examine hypothesis-driven differences among BPSD symptom clusters.

Keywords

caregivingAlzheimer's diseaseBPSDneuropsychiatric symptomsbehavior problems
Type
Review Article
Information
International Psychogeriatrics , Volume 24 , Issue 10 , October 2012 , pp. 1536 - 1552
Copyright
Copyright © International Psychogeriatric Association 2012

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References

Aalten, P. et al. (2003). Behavioral problems in dementia: a factor analysis of the neuropsychiatric inventory. Dementia and Geriatric Cognitive Disorders, 15, 99–105.CrossRefGoogle ScholarPubMed
Aalten, P., de Vugt, M. E., Jaspers, N., Jolles, J. and Verhey, F. R. (2005). The course of neuropsychiatric symptoms in dementia. Part II: relationships among behavioural sub-syndromes and the influence of clinical variables. International Journal of Geriatic Psychiatry, 20, 531–536.CrossRefGoogle ScholarPubMed
Allegri, R. F. et al. (2006). Neuropsychiatric symptoms as a predictor of caregiver burden in Alzheimer's disease. Neuropsychiatric Disease and Treatment, 2, 105–110.Google ScholarPubMed
Aneshensel, C. S., Pearlin, L. I., Mullan, J. T., Zarit, S. H. and Whitlach, C. J. (1995). Profiles in Caregiving: The Unexpected Career. San Diego, CA: Academic Press.Google Scholar
Asada, T., Kinoshita, T. and Kakuma, T. (2000). Analysis of behavioral disturbances among community-dwelling elderly with Alzheimer disease. Alzheimer Disease and Associated Disorders, 14, 160–167.CrossRefGoogle Scholar
Ballard, C. G. et al. (1995). The aetiology of depression in the carers of dementia sufferers. Journal of Affective Disorders, 35, 59–63.CrossRefGoogle ScholarPubMed
Ballard, C., Lowery, K., Powell, I., O'Brien, J. and James, I. (2000). Impact of behavioral and psychological symptoms of dementia on caregivers. International Psychogeriatrics, 12, 93–105.CrossRefGoogle Scholar
Bédard, M., Kuzik, R., Chambers, L., Molloy, D. W., Dubois, S. and Lever, J. A. (2005). Understanding burden differences between men and women caregivers: the contribution of care-recipient problem behaviors. International Psychogeriatrics, 17, 99–118.CrossRefGoogle ScholarPubMed
Berger, G., Bernhardt, T., Weimer, E., Peters, J., Kratzsch, T. and Frolich, L. (2005). Longitudinal study on the relationship between symptomatology of dementia and levels of subjective burden and depression among family caregivers in memory clinic patients. Journal of Geriatric Psychiatry & Neurology, 18, 119–128.CrossRefGoogle ScholarPubMed
Black, W. and Almeida, O. P. (2004). A systematic review of the association between the behavioral and psychological symptoms of dementia and burden of care. International Psychogeriatrics, 16, 295–315.CrossRefGoogle ScholarPubMed
Brink, T. L., Yesavage, J. A., Lum, O., Heersema, P., Adey, M. B. and Rose, T. L. (1982). Screening tests for geriatric depression. Clinical Gerontologist, 1, 37–43.CrossRefGoogle Scholar
Brodaty, H. and Luscombe, G. (1998). Psychological morbidity in caregivers is associated with depression in patients with dementia. Alzheimer Disease and Associated Disorders, 12, 62–70.CrossRefGoogle ScholarPubMed
Burns, A. (2000). The burden of Alzheimer's disease. International Journal of Neuropsychopharmacology, 3, 31–38.CrossRefGoogle ScholarPubMed
Caron, W., Boss, P. and Mortimer, J. (1999). Family boundary ambiguity predicts Alzheimer's outcomes. Psychiatry, 62, 347–356.CrossRefGoogle ScholarPubMed
Chappel, N. L. and Penning, M. (1996). Behavioural problems and distress among caregivers of people with dementia. Ageing and Society, 16, 57–73.CrossRefGoogle Scholar
Chiu, M. J., Chen, T. F., Yip, P. K., Hua, M. S. and Tang, L. Y. (2006). Behavioral and psychologic symptoms in different types of dementia. Journal of the Formosan Medical Association, 105, 556–562.CrossRefGoogle ScholarPubMed
Covinsky, K. E. et al. (2003). Patient and caregiver characteristics associated with depression in caregivers of patients with dementia. Journal of General Internal Medicine, 18, 1006–1014.CrossRefGoogle ScholarPubMed
Croog, S. H., Burleson, J. A., Sudilovsky, A. and Baume, R. M. (2006). Spouse caregivers of Alzheimer patients: problem responses to caregiver burden. Aging and Mental Health, 10, 87–100.CrossRefGoogle ScholarPubMed
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A. and Gornbein, J. (1994). The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 2308–2314.CrossRefGoogle ScholarPubMed
Danhauer, S. C., McCann, J. J., Gilley, D. W., Beckett, L. A., Bienias, J. L. and Evans, D. A. (2004). Do behavioral disturbances in persons with Alzheimer's disease predict caregiver depression over time? Psychology and Aging, 19, 198–202.CrossRefGoogle ScholarPubMed
Davis, L. L., Buckwalter, K. and Burgio, L. D. (1997). Measuring problem behaviors in dementia: developing a methodological agenda. Advances in Nursing Science, 20, 40–55.CrossRefGoogle ScholarPubMed
Donaldson, C., Tarrier, N. and Burns, A. (1998). Determinants of carer stress in Alzheimer's disease. International Journal of Geriatric Psychiatry, 13, 248–256.3.0.CO;2-0>CrossRefGoogle ScholarPubMed
Elmstahl, S., Ingvad, B. and Annerstedt, L. (1998). Family caregiving in dementia: prediction of caregiver burden 12 months after relocation to group-living care. International Psychogeriatrics, 10, 127–146.CrossRefGoogle ScholarPubMed
Finkel, S. I., Costa e Silva, J., Cohen, G., Miller, S. and Sartorius, N. (1996). Behavioral and psychological signs and symptoms of dementia: a consensus statement on current knowledge and implications for research and treatment. International Psychogeriatrics, 8, 497–500.CrossRefGoogle ScholarPubMed
Gallagher-Thompson, D., Brooks, J. O., III, Bliwise, D., Leader, J. and Yesavage, J. A. (1992). The relations among caregiver stress, “sundowning” symptoms, and cognitive decline in Alzheimer's disease. Journal of the American Geriatrics Society, 40, 807–810.CrossRefGoogle ScholarPubMed
Gonzalez-Salvador, M. T., Arango, C., Lyketsos, C. G. and Barba, A. C. (1999). The stress and psychological morbidity of the Alzheimer patient caregiver. International Journal of Geriatric Psychiatry, 14, 701–710.3.0.CO;2-#>CrossRefGoogle ScholarPubMed
Goode, K. T., Haley, W. E., Roth, D. L. and Ford, G. R. (1998). Predicting longitudinal changes in caregiver physical and mental health: a stress process model. Health Psychology, 17, 190–198.CrossRefGoogle ScholarPubMed
Grafstrom, M. and Winblad, B. (1995). Family burden in the care of the demented and nondemented elderly: a longitudinal study. Alzheimer Disease and Associated Disorders, 9, 78–86.CrossRefGoogle ScholarPubMed
Hadjistavropoulos, T., Taylor, S., Tuokko, H. and Beattie, B. L. (1994). Neuropsychological deficits, caregivers' perception of deficits and caregiver burden. Journal of the American Geriatrics Society, 42, 308–314.CrossRefGoogle ScholarPubMed
Harwood, D. G., Barker, W. W., Cantillon, M., Loewenstein, D. A., Ownby, R. and Duara, R. (1998). Depressive symptomatology in first-degree family caregivers of Alzheimer disease patients: a cross-ethnic comparison. Alzheimer Disease and Associated Disorders, 12, 340–346.CrossRefGoogle ScholarPubMed
Heok, K. E. and Li, T. S. (1997). Stress of caregivers of dementia patients in the Singapore Chinese family. International Journal of Geriatric Psychiatry, 12, 466–469.3.0.CO;2-U>CrossRefGoogle ScholarPubMed
Hooker, K. et al. (2002). Behavioral change in persons with dementia: relationships with mental and physical health of caregivers. Journal of Gerontology B: Psychological Sciences and Social Sciences, 57, 453–460.CrossRefGoogle ScholarPubMed
Jeon, Y. H. et al. (2011). Recommended measures for the assessment of behavioral disturbances associated with dementia. American Journal of Geriatric Psychiatry, 19, 403–415.CrossRefGoogle ScholarPubMed
Levesque, L., Cossette, S. and Laurin, L. (1995). A multidimensional examination of the psychological and social well-being of caregivers of a demented relative. Research on Aging, 17, 332–360.CrossRefGoogle Scholar
Lim, P. P. J., Sahadevan, S., Choo, G. K. and Anthony, P. (1999). Burden of caregiving in mild to moderate dementia: an Asian experience. International Psychogeriatrics, 11, 411–420.CrossRefGoogle ScholarPubMed
Lim, Y. M., Son, G. R., Song, J. A. and Beattie, E. (2008). Factors affecting burden of family caregivers of community-dwelling ambulatory elders with dementia in Korea. Archives of Psychiatric Nursing, 22, 226–234.CrossRefGoogle ScholarPubMed
LoGiudice, D., Waltrowicz, W., McKenzie, S., Ames, D. and Flicker, L. (1995). Prevalence of dementia among patients referred to an aged care assessment team and associated stress in their carers. Australian Journal of Public Health, 19, 275–279.CrossRefGoogle Scholar
Magai, C. and Cohen, C. I. (1998). Attachment style and emotion regulation in dementia patients and their relation to caregiver burden. Journal of Gerontology B: Psychological Sciences and Social Sciences, 53, 147–154.CrossRefGoogle ScholarPubMed
Mahoney, R., Regan, C., Katona, C. and Livingston, G. (2005). Anxiety and depression in family caregivers of people with Alzheimer disease: the LASER-AD study. American Journal of Geriatric Psychiatry, 13, 795–801.CrossRefGoogle ScholarPubMed
Molloy, D. W., Lever, R., Bedard, M., Guyatt, G. and Butt, G. (1996). Burden in care-givers of older adults with impaired cognition: the relationship with dysfunctional behaviors, daily living and mood. Annals of the Royal College of Physicians and Surgeons of Canada, 29, 151–154.Google Scholar
Neundorfer, M. M., McClendon, M. J., Smyth, K. A., Stuckey, J. C., Strauss, M. E. and Patterson, M. B. (2001). A longitudinal study of the relationship between levels of depression among persons with Alzheimer's disease and levels of depression among their family caregivers. Journal of Gerontology B: Psychological Sciences and Social Sciences, 56, 301–313.CrossRefGoogle ScholarPubMed
Onishi, J., Suzuki, Y., Umegaki, H., Nakamura, A., Endo, H. and Iguchi, A. (2005). Influence of behavioral and psychological symptoms of dementia (BPSD) and environment of care on caregivers' burden. Archives of Gerontology and Geriatrics, 41, 159–168.CrossRefGoogle ScholarPubMed
Pearlin, L. I., Mullan, J. T., Semple, S. J. and Skaff, M. M. (1990). Caregiving and the stress process: an overview of concepts and their measures. Gerontologist, 30, 583–594.CrossRefGoogle ScholarPubMed
Pinquart, M. and Sorensen, S. (2003a). Associations of stressors and uplifts of caregiving with caregiver burden and depressive mood: a meta-analysis. Journal of Gerontology B: Psychological Sciences and Social Sciences, 58, 112–128.CrossRefGoogle ScholarPubMed
Pinquart, M. and Sorensen, S. (2003b). Differences between caregivers and noncaregivers in psychological health and physical health: a meta-analysis. Psychology and Aging, 18, 250–267.CrossRefGoogle ScholarPubMed
Reis, M. F., Gold, D. P., Andres, D., Markiewicz, D. and Gauthier, S. (1994). Personality traits as determinants of burden and health complaints in caregiving. International Journal of Aging and Human Development, 39, 257–271.CrossRefGoogle ScholarPubMed
Reisberg, B., Auer, S. R. and Monteiro, I. M. (1996). Behavioral pathology in Alzheimer's disease (BEHAVE-AD) rating scale. International Psychogeriatrics, 8, 301–308.CrossRefGoogle ScholarPubMed
Riello, R., Geroldi, C., Zanetti, O. and Frisoni, G. B. (2002). Caregiver's distress is associated with delusions in Alzheimer's patients. Behavioral Medicine, 28, 92–98.CrossRefGoogle ScholarPubMed
Robinson, K. M., Adkisson, P. and Weinrich, S. (2001). Problem behaviour, caregiver reactions, and impact among caregivers of persons with Alzheimer's disease. Journal of Advanced Nursing, 36, 573–582.CrossRefGoogle ScholarPubMed
Rymer, S., Salloway, S., Norton, L., Malloy, P., Correia, S. and Monast, D. (2002) Impaired awareness, behavior disturbance, and caregiver burden in Alzheimer disease. Alzheimer Disease and Associated Disorders, 16, 248–253 CrossRefGoogle ScholarPubMed
Schulz, R., O'Brien, A. T., Bookwala, J. and Fleissner, K. (1995). Psychiatric and physical morbidity effects of dementia caregiving: prevalence, correlates, and causes. Gerontologist, 35, 771–791.CrossRefGoogle ScholarPubMed
Schulz, R. and Williamson, G. M. (1991). A 2-year longitudinal study of depression among Alzheimer's caregivers. Psychology and Aging, 6, 569–578.CrossRefGoogle ScholarPubMed
Shaji, K. S., George, R. K., Prince, M. J. and Jacob, K. S. (2009). Behavioral symptoms and caregiver burden in dementia. Indian Journal of Psychiatry, 51, 45–49.CrossRefGoogle ScholarPubMed
Son, J., Erno, A., Shea, D. G., Femia, E. E., Zarit, S. H. and Stephens, M. A. (2007). The caregiver stress process and health outcomes. Journal of Aging Health, 19, 871–887.CrossRefGoogle ScholarPubMed
Teri, L., Truax, P., Logsdon, R., Uomoto, J., Zarit, S. and Vitaliano, P. P. (1992). Assessment of behavioral problems in dementia: the revised memory and behavior problems checklist. Psychology and Aging, 7, 622–631.CrossRefGoogle ScholarPubMed
Tun, S. M., Murman, D. L. and Colenda, C. C. (2008). Concurrent validity of neuropsychiatric subgroups on caregiver burden in Alzheimer disease patients. American Journal of Geriatric Psychiatry, 16, 594–602.CrossRefGoogle ScholarPubMed
Victoroff, J., Mack, W. J. and Nielson, K. A. (1998). Psychiatric complications of dementia: impact on caregivers. Dementia and Geriatric Cognitive Disorders, 9, 50–55.CrossRefGoogle ScholarPubMed
Wadley, V. G. and Haley, W. E. (2001). Diagnostic attributions versus labeling: impact of Alzheimer's disease and major depression diagnoses on emotions, beliefs, and helping intentions of family members. Journal of Gerontology B: Psychological Sciences and Social Sciences, 56, 244–252.CrossRefGoogle ScholarPubMed
Weiner, B. (1986). An Attributional Theory of Motivation and Emotion. New York: Springer-Verlag.CrossRefGoogle Scholar
Zarit, S. H., Reever, K. E. and Bach-Peterson, J. (1980). Relatives of the impaired elderly: correlates of feelings of burden. Gerontologist, 20, 649–655.CrossRefGoogle ScholarPubMed