Date Presented 3/31/2017
Despite much reporting on the association between neuropsychiatric symptoms (NPS) of dementia and caregiver burden, little preparatory work has informed whether the type of NPS influences burden level. This exploratory factor analysis with 569 dyads reports clinically meaningful findings.
Primary Author and Speaker: Paul Arthur
Contributing Authors: John Kairalla, William C. Mann, Laura Gitlin
PURPOSE: The purpose of this study was to examine if type of neuropsychiatric symptoms (NPS) influences caregiver burden. Much has been reported on the association between NPS of dementia and caregiver (CG) burden (Ornstein & Gaugler, 2012), though far less preparatory work has been published regarding the influence of symptom type.
DESIGN: Exploratory factor analysis (EFA) with oblique rotation was performed with the Agitated Behavior in Dementia Scale (ABID; Logsdon et al., 1999) to develop a clinically useful structure to identify symptom types. A cross-sectional (observational) design was used to explore the relationship between NPS type and caregiver burden. Participants were 569 dyads (CG–care recipient [CR] pairs) selected from baseline data sets of three completed clinical trials that used identical reporting measures.
METHOD: The study was approved by the University of Florida’s institutional review board (#16U0053). Secondary analysis was performed with baseline data. CG burden was represented by the Zarit Short-Form Burden Scale (Bédard et al., 2001) and neuropsychiatric symptoms by the ABID. Descriptive statistics and frequencies were used for demographic and contextual reporting. EFA was performed with the ABID with fit criteria of 0.3, KMO statistic >0.6, and Bartlett’s test at a = .05. Unstandardized beta scores informed the strength and direction of the relationship. Dummy variables were created to differentiate possible effect location shifts between the three studies.
RESULTS: A three-factor model was indicated by EFA, with 12 of 16 NPS assigned across factors: (1) aggression with verbal attributes, (2) psychosis, and (3) aggression with physical attributes. Four NPS were not sufficiently correlated (>0.3) with any factor. CG burden was measured at a mean of 21.49 (SD = 9.27, range = 1–48), with higher scores indicating greater burden. When controlling for historical covariates, all factors were significantly associated with the burden outcome: Factor 1, p < .002; Factor 2, p < .002; and Factor 3, p < .001. The strongest predictor of CG burden, as reflected by the unstandardized beta score, was Factor 3 (physical aggression), B = .297, followed by Factor 2 (psychosis), B = .26, and Factor 1 (verbal aggression), B = .20.
DISCUSSION: Based on previous factor analyses with dementia symptoms (Aalten et al., 2003), a three- or four-factor model was expected. Due to the agitated theme of the inventory, further separation of factors was likely not achievable. This study complements evidence that CG burden is present with dementia and adds that burden can be exacerbated by symptom type. Clinically, it clarifies treatment assumptions made for all cases of dementia and promotes hastened treatment regimens for dyads experiencing select NPS.
IMPACT STATEMENT: This study provides a clinically useful factor structure in which to inquire regarding NPS within the clinic and provides linear evidence of the relationship between types of NPS and caregiver burden. It provides further evidence for addressing CR symptoms and caregiver well-being in dementia though family-centered care.
References
Aalten, P., de Vugt, M. E., Lousberg, R., Korten, E., Jaspers, N., Senden, B., . . . Verhey, F. R. (2003). Behavioral problems in dementia: A factor analysis of the neuropsychiatric inventory. Dementia and Geriatric Cognitive Disorders, 15, 99–105. https://doi.org/10.1159/000067972
Bédard, M., Molloy, D. W., Squire, L., Dubois, S., Lever, J. A., O’Donnell, M. (2001). The Zarit Burden Interview: A new short version and screening version. Gerontologist, 41, 652–657. https://doi.org/10.1093/geront/41.5.652
Logsdon, R. G., Teri, L., Weiner, M. F., Gibbons, L. E., Raskind, M., Peskind, E., . . . Thal, L. J. (1999). Assessment of agitation in Alzheimer’s disease: The Agitated Behavior in Dementia Scale. Journal of the American Geriatrics Society, 47, 1354–1358. https://doi.org/10.1111/j.1532-5415.1999.tb07439.x
Ornstein, K., & Gaugler, J. E. (2012). 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. International Psychogeriatrics, 24, 1536–1552. https://doi.org/10.1017/S1041610212000737
