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A systematic review of the association between the Behavioral and Psychological Symptoms of Dementia and burden of care

Published online by Cambridge University Press:  24 September 2004

Warwick Black  and
Osvaldo P. Almeida
Warwick Black
Affiliation:
Consultant Psychiatrist, Perth Clinic, Australia
Osvaldo P. Almeida
Affiliation:
Professor of Geriatric Psychiatry, School of Psychiatry and Clinical Neurosciences of the University of Western Australia and Royal Perth Hospital, Australia
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Abstract

Background: Several reports have indicated that the Behavioral and Psychological Symptoms of Dementia (BPSD) are associated with increased burden of care, carer depression and increased rates of institutionalization of patients. The present study aims to review the association between these variables in cross-sectional as well as longitudinal studies.

Methods: Systematic review and meta-analysis of all available information published in English between January 1990 and December 2001 was made. Case-reports, case-series and studies with 20 or fewer subjects were excluded from the analyses.

Results: Thirty articles are included in the review of cross-sectional data and 12 in the systematic review of longitudinal data. Pooled correlation coefficients were generated for the relationship between BPSD and caregiver burden (rpooled=0.57; 95% CI=0.52 to 0.62), caregiver psychological distress (rpooled=0.41; 95% CI=0.32 to 0.49) and caregiver depression (rpooled=0.30; 95% CI=0.21 to 0.39), suggesting that these concepts have a moderately strong association. Multivariate data, on the whole, further supported the notion that BPSD are a predictor of burden of care and of psychological distress and depression. Limited longitudinal data made clarifying the temporal relationahip between BPSD and the psychological sequelae of care (PSC) difficult. The limited data pertaining to the relationship between BPSD and institutionalization suggest that caregiver variables may be more important in predicting institutionalization than BPSD. Methodological issues and limitations associated with this type of investigation were also considered.

Conclusion: The results of this review support, but do not conclusively establish, the association between BPSD and PSC. We propose that the concept of burden of care be abandoned in favor of more clinically relevant outcomes such as caregiver depression.

Keywords

dementiaAlzheimer's diseaseaggressionhallucinationdelusionpsychosisdepressionanxietyirritabilitybehavioural and psychological symptomsburdenstresscarercaregiverresidential caresystematic review
Type
Review Article
Information
International Psychogeriatrics , Volume 16 , Issue 3 , September 2004 , pp. 295 - 315
Copyright
© International Psychogeriatric Association 2004

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