Author:
Kim Bokyoung,Noh Gie Ok,Kim Kyunghee
Abstract
Abstract
Background
Studies reported the relationship between behavioural and psychological symptoms of dementia (BPSD), cognitive function, caregiver burden, and therapeutic effects. However, the causal relationship between BPSD in community-dwelling patients with Alzheimer’s disease (AD) and caregiver burden is yet to be established. This study aimed to classify BPSD in patients with AD and identify the relationship between BPSD and the factors affecting family caregiver burden.
Methods
Path analysis was conducted at a neurology outpatient clinic of a tertiary general hospital in South Korea. The medical records of 170 patients, aged ≥50 years, diagnosed with or suspected for AD were retrospectively reviewed. We investigated cognitive function (Korean version of the Mini-Mental-State Exam), dementia stages (Korean version of the Expanded Clinical Dementia Rating scale), depression (Short-form Geriatric Depression Scale-Korea), activities of daily living (ADL; Korean version of the Barthel Activities of Daily Living index), instrumental activities of daily living (IADL; Seoul-Instrumental Activities of Daily Living), and BPSD and caregiver burden (Korean Neuropsychiatric Inventory). Considering the characteristic features of BPSD with various symptoms, BPSD was classified using factor analysis. Factor extraction was performed using principal component analysis, followed by Varimax factor rotation.
Results
Mean total BPSD score was 17.66 ± 20.67, and the mean score for family caregiver burden was 9.65 ± 11.12. Symptom cluster-1 (hyperactivity symptoms) included disinhibition, irritability, and agitation/aggression. Symptom cluster-2 (psychosis symptoms) included hallucinations, anxiety, elation/euphoria, delusions, and depression/dysphoria. Symptom cluster-3 (physical behaviour symptoms) included appetite and eating abnormalities, apathy/indifference, aberrant motor behaviour, sleep, and night-time behaviour disturbances. Dementia stages, ADL, and IADL had indirect effects on family caregiver burden through hyperactivity, psychosis, and physical behaviour symptoms, indicating that BPSD exerted a complete mediating effect.
Conclusions
Unlike previous studies, we classified BPSD symptoms into similar symptom clusters to evaluate its effect on caregiver burden, rather than collectively investigating the 12 symptoms of BPSD. As the dementia stage worsens, symptom clusters in BPSD serve as a medium between ADL and IADL degradation and for the increase in caregivers’ burden. The development and implementation of therapeutic, nursing interventions, and policies focusing on dementia stages, ADL, and IADL, delaying and preventing BPSD can alleviate family caregivers’ burden.
Publisher
Springer Science and Business Media LLC
Subject
Geriatrics and Gerontology
Reference65 articles.
1. National Institute of Dementia. Korean dementia observatory 2019. https://ansim.nid.or.kr/community/pds_view.aspx?bid=209. Accessed 13 September 2020.
2. WHO. Dementia 2019. https://www.who.int/news-room/fact-sheets/detail/dementia. Accessed 28 August 2020.
3. Cerejeira J, Lagarto L, Mukaetova-Ladinska EB. Behavioural and psychological symptoms of dementia. Front Neurol. 2012;3:73.
4. Mintzer JE, Hoernig KS, Mirski DF. Treatment of agitation in patients with dementia. Clin Geriatr Med. 1998;14:147–75.
5. Song JA, Park JW, Kim HJ. Impact of behavioral and psychological symptoms of dementia on caregiver burden in nursing homes. J Korean Gerontololgical Nurs. 2013;15:62–74.