Difference in determinants of caregiver burden between amnestic mild cognitive impairment and mild Alzheimer׳s disease
Introduction
Few tasks are more challenging than caring for a family member with dementia (Whitebird et al., 2013). Caregivers of patients with dementia experience a greater burden than those caring for non-demented patients (Guerra-Silla et al., 2011). As a result, family caregivers may experience significant mental health problems, as well as a deterioration of their own physical health (Hayashi et al., 2013). Thus, alleviation of the caregiver burden has become a primary public health goal (Arai and Zarit, 2011).
Among dementing disorders, Alzheimer׳s disease (AD) is the leading cause of late-onset dementia worldwide, and among caregivers of AD patients, 68% were highly burdened and 65% exhibited depressive symptoms (Papastavrou et al., 2007). In addition, the problem of the family burden of caring for persons with AD is a common challenge in both developed and developing countries (Chan, 2010).
Amnestic mild cognitive impairment (aMCI) is a risk state for AD that is characterized by a deficit in memory with preserved daily functioning (McLaughlin et al., 2014). The annualized conversion rates of aMCI to AD ranged from 11% to 16.5% for studies recruiting from clinics and from 7.4% to 8.9% for community samples (Ward et al., 2013). Caregivers of patients with aMCI were reported to already experience a need for increased services comparable to those of individuals caring for AD patients (Ryan et al., 2010).
It is plausible that in different stages of dementing diseases, the degree of the burden is different and that different factors influence the caregiver burden. However, there have been only a few studies comparing the burden of caregivers for dementia and aMCI patients. Based on previous research including our own (Gallagher et al., 2011, Fisher et al., 2011, Hayashi et al., 2013), we anticipated that the caregiver burden of caregivers for AD patients is more severe than that of caregivers for aMCI patients. Moreover, little is known about whether the risk factors of caregiver burden for patients with aMCI are similar to those for patients with AD (Ryan et al., 2012). We postulated that similar risk factors contribute to caregiver burden of patients with AD and aMCI, but that inability to perform activities of daily (ADL) life may be important in more advanced stages of the disease.
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Participants
Eighty five consecutive caregivers of subjects with aMCI and 106 consecutive caregivers of subjects with mild AD were recruited from the outpatient unit of the Memory Clinic of Okayama University Hospital between September 2008 and April 2012 according to the following criteria.
Inclusion criteria for caregivers were (1) being the family caregiver of an outpatient with aMCI or mild AD, (2) living with the patient or visiting him or her daily, and (3) being cognitively intact. Exclusion criteria
Participants
Demographic characteristics of participants are shown in Table 1. There were 85 patients with aMCI (CDR score 0.5) and 106 patients with mild AD (CDR score 0.5 or 1). The percentages of patients who were living alone were 10.6% (n=9) with aMCI and 14.2% (n=15) with mild AD. Patients taking anti-dementia medicine were 24.7% (n=21) in aMCI and 43.4% (n=46) in mild AD. Results of neuropsychological tests are shown in Table 2. All caregiver burden scores, cognitive test scores, and scores of
Discussion
We showed here two significant findings. One is that the caregiver burden in mild AD is more severe than that in aMCI. The other is that major determinant of the caregiver burden was the same in both aMCI and AD, but that somewhat different factors additionally affect the caregiver burden in aMCI and AD. These results are mostly in the expected directions.
Generally, psychotic symptoms paired with poor instrumental activities of daily living (IADL) functioning generate the greatest burden, while
Acknowledgements
We thank Ms. Horiuchi, Ms. Imai, Ms. Yabe, Ms. Tsuchiyama, and Ms. Fukushima for their skillful assistance for this study. This work was supported by a Grant from the Japanese Ministry of Education, Culture, Sports, Science and Technology (21591517), and the Zikei Institute of Psychiatry.
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