Elsevier

Psychiatry Research

Volume 226, Issue 1, 30 March 2015, Pages 242-246
Psychiatry Research

Difference in determinants of caregiver burden between amnestic mild cognitive impairment and mild Alzheimer׳s disease

https://doi.org/10.1016/j.psychres.2014.12.055Get rights and content

Highlights

  • The caregiver burden in mild Alzheimer׳s disease (AD) was more severe than that in amnestic mild cognitive impairment (aMCI).

  • In mild AD, the risk factors of caregiver burden were neurobehavioral symptoms and disturbances instrumental activities of daily living.

  • In aMCI, the risk factors of caregiver burden were neurobehavioral symptoms and memory dysfunction.

Abstract

Care for the disabled elderly can be stressful and exhausting, especially in cases of dementia. There have been a number of studies on the dementia caregiver burden, but studies focusing on differences by stages of the disease are rare. The caregiver burden of 85 caregivers of patients with amnestic mild cognitive impairment (aMCI) and 106 caregivers of patients with mild Alzheimer׳s disease (AD) was evaluated by the short version of the Japanese version of the Zarit Burden Interview (sZBI). The caregiver burden in mild AD was more severe than that in aMCI. In mild AD, the risk factors of caregiver burden were neurobehavioral symptoms and disturbances instrumental activities of daily living (IADL), whereas the risk factors in aMCI were neurobehavioral symptoms and memory dysfunction. The severity of dementing disease affects the caregiver burden, and somewhat different factors contribute to the burden at different stages. We should pay attention to different factors in evaluating and reducing the caregiver burden in aMCI and mild AD.

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.

Section snippets

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.

References (27)

  • M.F. Folstein et al.

    "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician

    Journal of Psychiatry Research

    (1975)
  • A. Kugo et al.

    Japanese version of the Frontal Assessment Battery for dementia

    Psychiatry Research

    (2007)
  • K. Seeher et al.

    Predictors and outcomes for caregivers of people with mild cognitive impairment: a systematic literature review

    Alzheimer׳s & Dementia

    (2013)
  • Y. Arai et al.

    Exploring strategies to alleviate caregiver burden: effects of the National Long-Term Care insurance scheme in Japan

    Psychogeriatrics

    (2011)
  • S.W. Chan

    Family caregiving in dementia: the Asian perspective of a global problem

    Dementia and Geriatric Cognitive Disorders

    (2010)
  • G.G. Fisher et al.

    Caring for individuals with dementia and cognitive impairment, not dementia: findings from the aging, demographics, and memory study

    Journal of the American Geriatric Society

    (2011)
  • D. Gallagher et al.

    Dependence and caregiver burden in Alzheimer׳s disease and mild cognitive impairment

    American Journal of Alzheimer׳s Disease and Other Dementias

    (2011)
  • L. Garand et al.

    Anticipatory grief in new family caregivers of persons with mild cognitive impairment and dementia

    Alzheimer Disease and Associated Disorders

    (2012)
  • M.G. Guerra-Silla et al.

    Psychometric evaluation of a Spanish language version of the Screen for Caregiver Burden (SCB) in caregivers of patients with mixed, vascular and Alzheimer׳s dementia

    Journal of Clinical Nursing

    (2011)
  • S. Hayashi et al.

    Burden of caregivers for patients with mild cognitive impairment in Japan

    International Psychogeriatrics

    (2013)
  • N. Hirono et al.

    Japanese version of the Neuropsychiatric Inventory—a scoring system for neuropsychiatric disturbance in dementia patients

    No To Shinkei

    (1997)
  • Y. Kobayashi

    Evaluation of needs for consultation of caregivers of patients with dementia

    Ronen Seishin Igaku Zasshi

    (2008)
  • K. Kumamoto et al.

    Cross-validation of the short version of the Japanese version of the Zarit Caregiver Burden Interview (J-ZBI 8)

    Nihon Ronen Igakkai Zasshi

    (2004)
  • Cited by (10)

    View all citing articles on Scopus
    View full text