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Alzheimer's & Dementia
Unprepared Caregivers Increase Dementia Activity in
Patients
Certain caregiver
styles, emotional state may bring them out
May 24, 2006- Troublesome symptoms that accompany
dementia, including Alzheimer's disease, – including wandering,
hallucinations and restlessness – may increase if the patients’
caregivers are young, less educated, over-burdened or depressed,
according to researchers from Wake Forest University School of Medicine
and colleagues.
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“These symptoms are part of the disease and the
caregivers aren’t causing them, but certain styles of caregiving may
bring them out,” said lead author Kaycee Sink, M.D., assistant professor
of gerontology at Wake Forest. “Our study identified characteristics of
caregivers that are linked to these difficult behaviors.”
Sink said understanding the link between caregiver
characteristics and patient behaviors could lead to more effective
treatment. Caregiver education and drug therapy have both proved to be
only mildly effective at reducing the symptoms. About 7 million people
in the United States have dementia and nearly 100 percent will develop
the behavioral symptoms at some point in the illness.
“These results are consistent with the idea that
caregiver characteristics, including their emotional state, could
contribute to neuropsychiatric (behavioral) symptoms in dementia
patients,” said Sink. “For example, it is possible that caregivers who
are burdened may be irritable and demonstrate less patience, which could
provoke the symptoms.”
The study, reported in the May issue of the Journal
of the American Geriatrics Society, involved almost 6,000 patients with
dementia, who lived in the community, and their caregivers. Almost half
of the caregivers were the patients’ spouses, and 31 percent were
daughters or daughters-in-law.
The symptoms assessed in the study were: constant
restlessness, constant talkativeness, hallucinations, paranoia, episodes
of unreasonable anger, combativeness, danger to self, danger to others,
destruction of property, repetitive questions, wandering, and waking the
caregiver. Behavioral symptoms are the No. 1 reason for nursing home
placement among dementia patients, Sink said, because it becomes too
difficult to provide care at home.
The researchers examined data on patients and
caregivers from the Medicare Alzheimer’s Disease Demonstration and
Evaluation (MADDE) study, which was designed to reduce burden and
depression in caregivers of patients with dementia. For the study,
caregivers were interviewed to get information about their age,
education, relationship to the patient, etc. Standard tests were used to
assess caregiver depression and burden, and caregivers were asked about
neuropsychiatric symptoms in the patients.
The researchers adjusted for variables that could
have influenced the results – such as patient characteristics and
severity of dementia. They also attempted to control for the possibility
that caregivers’ reports of neuropsychiatric symptoms didn’t reflect the
actual symptoms, but were influenced by the caregivers’ depression,
education or other characteristics.
The final analysis revealed that caregivers who
were younger, less educated, more depressed, more burdened or who spent
more hours per week giving care reported more of the behaviors in
patients.
The youngest caregivers reported 50 percent more of
the behaviors than the oldest caregivers. Each of the characteristics
was independently linked to more behaviors in patients. For example,
caregiver age alone, regardless of education or depression, affected the
number of symptoms.
Sink said that understanding more about the
caregiver-patient relationship may help researchers develop more
effective education tools.
“We are not trying to blame caregivers, but to
better understand the complex puzzle,” said Sink. “If we focus only on
the patient, we’re not going to solve the problem. We need to develop
better, non-drug treatments to handle these behaviors, and more tailored
caregiver education may be one answer.”
Funders of the research included the National
Institutes for Health.
Sink’s co-researchers are Kenneth Covinsky, M.D.,
Deborah Barnes, Ph.D., Robert Newcomer, Ph.D., and Kristine Yaffe, M.D.,
all with the University of California at San Francisco.
Wake Forest University Baptist Medical Center is an
academic health system comprised of North Carolina Baptist Hospital and
Wake Forest University Health Sciences, which operates the university’s
School of Medicine. U.S. News & World Report ranks Wake Forest
University School of Medicine 18th in family medicine, 20th in
geriatrics, 25th in primary care and 41st in research among the nation's
medical schools. It ranks 32nd in research funding by the National
Institutes of Health. Almost 150 members of the medical school faculty
are listed in Best Doctors in America.
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