Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA.
Int Psychogeriatr. 2013 Sep;25(9):1453-62. doi: 10.1017/S1041610213000768. Epub 2013 Jun 3.
The behavioral and psychological symptoms associated with dementia (BPSD) can be burdensome to informal/family caregivers, negatively affecting mental health and expediting the institutionalization of patients. Because the dementia patient-caregiver relationship extends over long periods of time, it is useful to examine how BPSD impact caregiver depressive symptoms at varied stages of illness. The goal of this study was to assess the association of BPSD that occur during early stage dementia with subsequent caregiver depressive symptoms.
Patients were followed from the early stages of dementia every six months for up to 12 years or until death (n = 160). Caregiver symptoms were assessed on average 4.5 years following patient's early dementia behaviors. A generalized estimating equation (GEE) extension of the logistic regression model was used to determine the association between informal caregiver depressive symptoms and BPSD symptoms that occurred at the earliest stages dementia, including those persistent during the first year of dementia diagnosis.
BPSD were common in early dementia. None of the individual symptoms observed during the first year of early stage dementia significantly impacted subsequent caregiver depressive symptoms. Only patient agitation/aggression was associated with subsequent caregiver depressive symptoms (OR = 1.76; 95% CI = 1.04-2.97) after controlling for concurrent BPSD, although not in fully adjusted models.
Persistent agitation/aggression early in dementia diagnosis may be associated with subsequent depressive symptoms in caregivers. Future longitudinal analyses of the dementia caregiving relationship should continue to examine the negative impact of persistent agitation/aggression in the diagnosis of early stage dementia on caregivers.
与痴呆相关的行为和心理症状（BPSD）会给非专业/家庭照顾者带来负担，对他们的心理健康产生负面影响，并加速患者的住院治疗。由于痴呆患者与照顾者的关系持续时间较长，因此研究 BPSD 在疾病不同阶段对照顾者抑郁症状的影响是很有用的。本研究的目的是评估在痴呆早期发生的 BPSD 与随后的照顾者抑郁症状之间的关联。
从痴呆早期开始，每 6 个月对患者进行一次随访，最长随访时间为 12 年或直至患者死亡（n=160）。在患者出现早期痴呆行为后平均 4.5 年评估照顾者的症状。使用广义估计方程（GEE）扩展的逻辑回归模型来确定非专业照顾者抑郁症状与在痴呆早期发生的 BPSD 症状之间的关联，包括在痴呆诊断的第一年持续存在的 BPSD 症状。
在痴呆早期，BPSD 很常见。在早期痴呆的第一年观察到的任何单个症状都没有显著影响随后的照顾者抑郁症状。只有患者的激越/攻击行为与随后的照顾者抑郁症状相关（OR=1.76；95%CI=1.04-2.97），在控制了同时存在的 BPSD 后，但在完全调整的模型中并非如此。
在痴呆诊断早期持续存在的激越/攻击行为可能与随后照顾者的抑郁症状有关。未来对痴呆照顾关系的纵向分析应继续研究在早期诊断痴呆时持续存在的激越/攻击行为对照顾者的负面影响。
