Alzheimer Café

Prior research has yielded discrepant findings regarding change in caregiver burden or depressive symptoms after institutionalization of persons with dementia. However, earlier studies often included small postplacement samples. In samples of 1,610 and 1,116 dementia caregivers with up to 6 months' and 12 months' postplacement data, respectively, this study identified predictors of change in caregiver burden and depressive symptoms following nursing home admission. Descriptive analyses found that caregivers reported significant and considerable decreases in burden in the 6- and 12-month postplacement panels. A number of variables predicted increased burden and depressive symptoms in the 6- and 12-month postplacement panels. Preplacement measures of burden and depressive symptoms, site (Florida), overnight hospital use, and spousal relationship appear to result in impaired caregiver well-being following nursing home admission. Incorporating more specific measures of stress, considering the influence of health-related transitions, and coordinating clinical strategies that balance caregivers' needs for placement with sustainability of at-home care are important challenges for future research.

An increase in caregiver burden and a decrease in social support have both been identified as predictors of poor caregiver psychological distress. However, little is known about the role of these factors in coronary artery bypass graft (CABG) caregivers. The purpose of this study was to investigate whether change in perceived social support from pre to post surgery mediated the relationship between change in caregiver burden and caregiver depressive symptoms and subjective well-being post surgery. A sample of 101 caregivers of elective CABG patients were assessed 28 days before and 62 days after patients’ surgery. Caregivers completed the Oberst Burden Scale, the Enhancing Recovery in Coronary Heart Disease (ENRICHD) Social Support Instrument, the Beck Depression Inventory, and the Control, Autonomy, Self-Realisation, and Pleasure (CASP-19) scale. Simple mediation analyses showed that change in social support significantly mediated both the relationship between change in caregiver burden and post-surgery depressive symptoms (unstandardised β = 0.041, 95% CI (0.005, 0.112)) and the relationship between change in caregiver burden and post-surgery subjective well-being (unstandardised β = 0.071, 95% CI (0.001, 0.200)). Psychological interventions aimed at the CABG caregiver population should promote social support to deal with the increase of caregivers’ tasks and demands after the patients’ surgery.

Background: Caregiver depression and burden have a detrimental effect on stroke survivors’ rehabilitation and are contributors to stroke survivors’ hospital readmission and institutionalization. The stroke caregiving trajectory is unique compared to other illnesses, and the effect of length of caregiving on stroke caregiver outcomes is poorly understood. Interventions can improve caregiver outcomes, but the optimal timing of these interventions is unclear.Objectives: We sought to determine the relationship between: (1) length of caregiving and stroke caregiver depressive symptoms and burden, and (2) length of caregiving and amount of change in depressive symptoms and burden following the Resources and Education for Stroke Caregivers’ Understanding and Empowerment (RESCUE) intervention – an online and telephone problem-solving, education, and support intervention.Methods: We analyzed retrospective data collected from 72 stroke caregivers who participated in the RESCUE intervention. Outcomes were caregiver depressive symptoms and burden. Data were analyzed using mixed-effects regression analysis.Results: Baseline depressive symptoms and burden were both negatively related to length of caregiving (p < 0.05). We found significant improvement in caregiver depressive symptoms and burden following an intervention. The interaction between changes in outcomes and length of caregiving was not significant for either depressive symptoms (p = 0.26) or burden (p = 0.10).Conclusions: This study contributes to the understanding of the relationship between length of caregiving and depression, burden, and intervention outcomes. Clinicians should recognize that the stroke caregiving trajectory can be nonlinear. Routine and repeated clinical assessment of caregiver well-being is needed, along with implementation of interventions when necessary, regardless of how much time has passed since the stroke.

The relationship between care recipients' depressive symptoms and those of caregivers remains unknown. We evaluated the association between the depressive status of caregivers and that of community-dwelling disabled care recipients. A prospective cohort study of 893 care recipients and paired caregivers was conducted. The care recipients were all eligible for a universal-coverage long-term care insurance program and their ages ranged from 65 to 104 years. They and their paired caregivers (age range 31-90 years) completed the 15-item Geriatric Depression Scale (GDS-15, score range: 0-15) assessment at baseline. The GDS-15 was used to measure the depression of caregivers and recipients with a threshold of <6/6+. The data included each care recipient's demographic characteristics, overall health status, basic activities of daily living, and comorbidities. The data also included the caregiver's demographic characteristics, including the caregiver's relationship to the recipient, and the caregiver's subjective burden as assessed by the Japanese version of the Zarit Burden Interview (ZBI). The mean GDS-15 scores of care recipients and caregivers were 6.7 points and 5.6 points, respectively. There was a positive correlation between the GDS-15 scores of caregivers and care recipients (r = 0.307, p<0.001). Multivariate logistic regression analysis adjusting for potential confounders including ZBI score indicated that the depressive symptoms of caregivers were associated with those whose care recipients were in the groups with moderate and high GDS-15 scores (OR: 1.97, 95% CI: 1.39-2.81, OR: 3.13, 95% CI: 1.87-5.24, respectively). Caregivers' depressive symptoms are associated with the depressive mood of the care recipients even after adjusting for confounders including caregiver burden.

Caregivers of adults with cancer often report a different understanding of the patient's prognosis than the oncologist. We examine the associations of caregiver-oncologist prognostic concordance with caregiver depressive symptoms, distress, and quality of life (QoL). We also explore whether these relationships differed by caregiver environment mastery, an individual's sense of control, and effectiveness in managing life situations. We used data from a national geriatric assessment cluster-randomized trial (URCC 13070) that recruited patients aged 70 years and older with incurable cancer considering any line of cancer treatment at community oncology practices, their caregivers, and their oncologists. At enrollment, caregivers and oncologists estimated the patient's prognosis (0-6 months, 7-12 months, 1-2 years, 2-5 years, and >5 years; identical responses were concordant). Caregivers completed the Ryff's environmental mastery at enrollment. At 4-6 weeks, caregivers completed the Patient Health Questionnaire-2 (depressive symptoms), distress thermometer, and 12-Item Short-Form Health Survey (quality of life [QoL]). We used generalized estimating equations in models adjusted for covariates. We then assessed the moderation effect of caregiver mastery. Of 411 caregiver-oncologist dyads (mean age = 66.5 years), 369 provided responses and 28% were concordant. Prognostic concordance was associated with greater caregiver depressive symptoms (β = 0.30; p = .04) but not distress or QoL. A significant moderation effect for caregiver depressive symptoms was found between concordance and mastery (p = .01). Specifically, among caregivers with low mastery (below median), concordance was associated with greater depressive symptoms (β = 0.68; p = .003). Caregiver-oncologist prognostic concordance was associated with caregiver depressive symptoms. We found a novel moderating effect of caregiver mastery on the relationship between concordance and caregiver depressive symptoms. Caregiver-oncologist prognostic concordance is associated with greater caregiver depressive symptoms, particularly in those with low caregiver mastery. When discussing prognosis with caregivers, physicians should be aware that prognostic understanding may affect caregiver psychological health and should assess their depressive symptoms. In addition, while promoting accurate prognostic understanding, physicians should also identify strengths and build resilience among caregivers.

Background Mild Cognitive Impairment (MCI) is often considered a prodromal phase of Lewy Body Dementia (LBD). While both conditions involve cognitive difficulties, they differ in the type and severity of non-cognitive symptoms. MCI is generally associated with mild cognitive changes and subtle neuropsychiatric, motor, and sleep disturbances. In contrast, LBD presents with more pronounced neuropsychiatric, motor, and sleep-related symptoms, which can affect cognitive performance. This study explores how these symptoms predict cognitive function in individuals with MCI and LBD, highlighting their distinct contribution to cognitive performance in each condition. Methods Data from N=36 patients with MCI, primarily Parkinson’s Disease-MCI (PD-MCI), and N=48 patients with LBD, including Parkinson’s Disease Dementia (PDD) and Dementia with Lewy Bodies (DLB) were analysed. Neuropsychiatric symptoms were assessed using the Neuropsychiatric Inventory, sleep with the Epworth Sleepiness Scale, motor symptoms with the Hoehn and Yahr scale, and cognitive function with the Addenbrooke’s Cognitive Examination. Correlation and regression analyses explored the relationship between these factors and their role in predicting performance Results In the MCI group, neuropsychiatric symptoms were positively correlated with motor symptoms (p = 0.004). In the LBD group, neuropsychiatric (p &amp;lt; 0.001) and motor symptoms (p = 0.03) were significantly associated with lower cognitive functioning. Additionally, in LBD, neuropsychiatric symptoms were positively correlated with both motor (p = 0.02) and sleep symptoms (p &amp;lt; 0.001). In MCI, sleep symptoms significantly predicted poorer cognitive functioning (p = 0.03), whereas in LBD, neuropsychiatric symptoms were the strongest predictor of reduced cognitive functioning (p = 0.02), even after adjusting for age and gender. Conclusion Different patterns were observed in how neuropsychiatric, motor, and sleep symptoms influence cognitive functioning in the MCI and LBD groups, highlighting the distinct roles of non-cognitive symptoms in each condition. Early identification of these symptoms may offer valuable insights for monitoring cognitive functioning over time in these clinical populations.

Studies have shown that cognitive behavioural therapy (CBT) for older people with cognitive decline and depression/anxiety improves negative moods. However, CBT research focusing on this population in Japan is limited. This study aimed to evaluate the feasibility of a cognitive behavioural program for people with cognitive decline. Sixteen Japanese patients with mild dementia (n = 3) and mild cognitive impairment (MCI, n = 13) participated in the study. A single-arm, pre–post study was implemented in two hospitals in Japan. The CBT program included eight bi-weekly sessions. The feasibility outcomes (satisfaction, understanding and usefulness) were measured immediately after completing the sessions, and depression, anxiety, quality of life (QOL), neuropsychiatric symptoms, and caregiver burden were measured at three time points (i.e. before, immediately after, and 3-month follow-up). Ten MCI participants attended all sessions and the mean patient satisfaction scores using the Client Satisfaction Questionnaire were 31.0±10.05 out of 32. Linear mixed model analyses demonstrated that the time effect was significant for depression (d = 1.62), anxiety (d = 1.39), and QOL (d = 1.00) for the patients, and significant for anxiety (d = 1.08) for their caregivers. The study found that this CBT program is feasible and acceptable for older Japanese people with cognitive decline. The program also improved patients’ QOL, anxiety and depressive symptoms, and decreased caregivers’ anxiety. Key learning aims (1) Recently, studies have shown that CBT for older people living with dementia has been effective in treating their depression and anxiety. However, evidence for the efficacy of CBT and other curative or care options for people living with dementia is limited in Japan. (2) We studied a short-period CBT program and found that it was likely to be feasible and acceptable for use among older Japanese people with mild cognitive impairment, that it may improve negative mood among this group, and that it may lessen the care burden for caregivers. (3) Furthermore, we found that caregiver involvement in the implementation of CBT for older people may be effective in improving the mood of family members.

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessNeuropsychiatric Symptoms Implicated in Conversion From MCI to DementiaMark MoranMark MoranSearch for more papers by this authorPublished Online:3 Apr 2015https://doi.org/10.1176/appi.pn.2015.3b9AbstractNeuropsychiatric symptoms may be etiologic for dementia through neuroendocrine axis activation, or they may interact synergistically with a biological factor; either of these suggests that treating neuropsychiatric symptoms might delay dementia onset.Neuropsychiatric symptoms in the presence of mild cognitive impairment (MCI), including depression, appear to significantly increase the risk of conversion to dementia—either amnestic or Alzheimer’s type dementia—according to a report published February 20 in AJP in Advance.Researchers at Johns Hopkins University School of Medicine and in the United Kingdom searched PubMed (from 1946) and Web of Knowledge (from 1900) through May 22, 2013 (updated June 5, 2014), using a variety of terms such as “mild cognitive,” “cognitive impairment,” and “age associated cognitive decline” included in longitudinal studies reporting potentially modifiable risk factors for incident dementia in people with MCI. There were 76 eligible articles reporting epidemiologic and clinical studies.A principal finding from the study was that diabetes, prediabetes, metabolic syndrome, and low serum folate levels increased risk of conversion from amnestic MCI to Alzheimer’s dementia and from any type or nonamnestic MCI to all-cause dementia. But the researchers also found that the presence of neuropsychiatric symptoms predicted conversion to all-cause dementia. Among the findings are the following:There is evidence that more depressive symptoms predict conversion from any-type MCI to all-cause dementia from epidemiologic studies, but the evidence is inconsistent in clinical studies; it is also inconsistent as to whether depressive symptoms predict conversion from amnestic MCI to Alzheimer’s dementia or to any-cause dementia. There is evidence from clinical studies that the presence of neuropsychiatric symptoms in people with any-type MCI, but not their overall levels of symptoms, predicts conversion to all-cause dementia. There is inconsistent evidence about whether anxiety symptoms are associated with conversion from amnestic MCI to Alzheimer’s dementia and about whether apathy predicts the risk of conversion from amnestic MCI to Alzheimer’s dementia or from any-type MCI to dementia.“A third to three-quarters of people with MCI have neuropsychiatric symptoms, most commonly depression, anxiety, apathy, and irritability,” the researchers stated. “Neuropsychiatric symptoms predicted conversion from any-type MCI to all-cause dementia. Neuropsychiatric symptoms may be etiologic for dementia, for example through neuroendocrine axis activation, or they may interact synergistically with a biological factor, such as genetic predisposition. Either of these putative relationships suggests that treating neuropsychiatric symptoms could theoretically delay dementia.” Dilip Jeste, M.D., said that between 35 percent and 45 percent of people with mild cognitive impairment develop dementia within three years and that the financial costs of dementia exceed those of heart disease and cancer.Dilip Jeste, M.D.Dilip Jeste, M.D., a past APA president and a professor of psychiatry and neurosciences and the Estelle and Edgar Levi Chair in Aging at the University of California, San Diego, said that the costs associated with dementia make identification of risk factors a valuable public-health task. “This is an important paper based on a careful meta-analysis of 76 published articles reporting longitudinal studies on potentially modifiable risk factors for development of dementia in persons with mild cognitive impairment, or MCI,” he told Psychiatric News. “In DSM-5, dementia and MCI are labeled major and minor neurocognitive disorders, respectively. In general, between 35 percent and 45 percent of people with MCI develop dementia within three years. The total financial cost of dementia exceeds that of heart disease and cancer. Therefore, identifying and controlling risk factors for developing dementia among older adults with MCI is of clear public-health significance.“These authors report that diabetes, pre-diabetes, metabolic syndrome, neuropsychiatric symptoms including depression, and lower serum folate levels were associated with variably increased risk of dementia, whereas the Mediterranean diet seemed to reduce the risk of developing dementia in patients with MCI,” Jeste added. “These findings suggest that control and prevention of diabetes, treatment of depressive and other neuropsychiatric symptoms, and use of a Mediterranean diet and of folate supplements may be helpful in lowering the risk of dementia in persons with MCI. A word of caution in interpreting the present results is that they are not based on large, randomized, controlled trials in individuals with MCI. Associations do not necessarily indicate causality or even directionality. Nonetheless, the recommendations should be helpful in at least some people and are consistent with good clinical practice.” ■“Modifiable Predictors of Dementia in Mild Cognitive Impairment: A Systematic Review and Meta-Analysis” can be accessed here. ISSUES NewArchived

Family caregivers of those with developmental disabilities have higher rates of depression and anxiety compared with caregivers of those without development disability. Few studies have examined factors that contribute to caregiver depression, including the appraisal of caregiving responsibilities and the physical fitness and daily function of the care recipient. The purpose of this study was to identify intrapersonal (caregiver) and interpersonal (care recipient) factors associated with depressive symptoms in caregivers of adults with Down syndrome (DS). Twenty-four adults with DS participating in a 12-month physical activity trial completed physical fitness and function tests (VO2peak, hand grip strength, timed up and go, five times sit to stand) and activities of daily living (ADL) surveys at their baseline visit. Caregivers (n = 24) of the adults with DS completed surveys on caregiving distress, quality of life (QoL) and depressive symptoms. We evaluated the associations of these assessments on caregiver depressive symptoms using Mann-Whitney U tests and Spearman correlations. Adults with DS were 23 ± 7.5 years, 58% female; caregivers were 54 ± 10 years, 100% female, 96% family members. Caregiver depressive symptoms were significantly associated with caregiving distress (p = 0.024) and caregiving QoL (r = -0.58, p = 0.003). Hand grip strength of care recipients was inversely correlated with caregiver depressive symptoms (r = -0.45, p = 0.03), but other assessments of physical function and ADL were not associated with caregiver depressive symptoms. Caregiver depressive symptoms were related to modifiable factors related to the caregiver and care recipient. Intervening to improve caregiving appraisal and functional strength of the care recipient may positively impact caregiver mental health.

The association between caregiver's stress and depressive symptoms, and sociodemographic and clinical characteristics of Alzheimer's patients and caregivers was evaluated in 63 primary caregivers consecutively recruited at the Alzheimer's Dementia Research and Care Unit of Brescia, northern Italy. Family caregivers' informal support was also evaluated. Patients' behavioral disturbances, and the number of persons who lived in the household were the main correlates of caregivers' stress. The greater the number of persons, the lower the report of caregiver stress. Lower frequency of visits of friends or relatives, caregivers' poor health and higher age, and the presence of patients' behavioral disturbances were the main determinants of caregivers' depressive symptoms. Cognitive impairment of patients was not correlated to caregivers' distress. Our study underlines that the imperatives of dementia and caregiving appear to be so significant that they have similar consequences in the Italian population as well as in other very different cultures. Factors related to primary caregivers, other than patients' behavior, such as informal supports or caregivers' health and age, should be taken into account in the evaluation of caregivers' burden.

Evidence from predominately non-Hispanic White populations indicates that emergency room (ER) admissions and hospitalizations by older adults with and without dementia are associated with caregiver stress and depressive symptoms. These results may not generalize to Hispanic populations because of cultural differences in caregiving roles, responsibilities, and perspectives about care burden. Investigate the association between ER admissions and hospitalizations by Mexican American older adults with and without dementia and symptoms of depression and stress among family caregivers. Data came from the 2010/11 wave of the Hispanic Established Populations for the Epidemiologic Study of the Elderly and Medicare claims files. The final sample included 326 older adults and their caregivers. Negative binomial regression was used to model the association between hospitalizations and ER admissions by older adults in the previous two years and caregivers' depressive symptoms and stress in 2010/11. The number of older adult ER admissions and hospitalizations was not associated with caregiver depressive symptoms. Two or more ER admissions (incident rate ratio [IRR] = 1.26, 95% CI = 1.05-1.51) and two or more hospitalizations (IRR = 1.32, 95% CI = 1.07-1.61) were associated with significantly higher caregiver stress. Additionally, ER admissions and hospitalizations for a circulatory disease or injury and poisoning were associated with significantly higher caregiver stress. These associations were not modified by the care recipient's dementia status. Hospitalizations and ER admissions by older Mexican Americans were associated with greater caregiver stress but not depressive symptoms. These associations were similar for caregivers to older adults with and without dementia.

Neuropsychiatric symptoms (NPS) are common in patients with mild cognitive impairment (MCI). Little is known, however, about how NPS vary by MCI subtype (i.e. amnestic, single domain non-memory, and multiple domain). In addition, it is unclear whether NPS increase risk of progression to dementia. We investigated the distribution of NPS across MCI subtypes and determined whether NPS increase risk of progression to dementia. Participants were 521 patients diagnosed with MCI at the Alzheimer's Research Centers of California between 1988 and 1999. At baseline, patients were classified into MCI subtypes and were assessed for NPS. The mean number of NPS was 2.3 (range 0-9.6; 74% had > or =1 NPS). Patients with > or =4 NPS had more medical comorbidities and greater functional impairment (p < or = 0.0001 for both). Patients with > or =4 NPS were more likely than patients with 0-3 NPS to have amnestic MCI (81% vs 71%, respectively, p = 0.03), and patients with amnestic MCI were more likely than those with other subtypes to exhibit depressive symptoms. Patients with > or =4 NPS had nearly 2.5 times the odds of developing dementia at follow-up than patients with 0-3 NPS (adjusted OR = 2.44, 95% CI 1.07, 5.55). NPS are common in MCI patients. Those with an elevated number of NPS may be more likely to have the amnestic subtype of MCI, and depression may be more common in amnestic MCI than in other subtypes. An elevated number of NPS may increase risk of progression to dementia for patients with MCI.

Cognitive impairments associated with aging and dementia are major sources of neuropsychiatric symptoms (NPs) and deterioration in quality of life (QoL). Preventive measures to both reduce disease and improve QoL in those affected are increasingly targeting individuals with mild cognitive impairment (MCI) at early disease stage. However, NPs and QoL outcomes are too commonly overlooked in intervention trials. The purpose of this study was to test the effects of physical and cognitive training on NPs and QoL in MCI. Baseline data from an MCI court (N = 93, mean age 74.9 ± 4.7) enrolled in the Train the Brain (TtB) study were collected. Subjects were randomized in two groups: a group participated to a cognitive and physical training program, while the other sticked to usual standard care. Both groups underwent a follow-up re-evaluation after 7months from baseline. NPs were assessed using the Neuropsychiatric Inventory (NPI) and QoL was assessed using Quality of Life-Alzheimer's Disease (QOL-AD) scale. After 7months of training, training group exhibited a significant reduction of NPs and a significant increase in QOL-AD with respect to no-training group (p = 0.0155, p = 0.0013, respectively). Our preliminary results suggest that a combined training can reduce NPs and improve QoL. Measuring QoL outcomes is a potentially important factor in ensuring that a person with cognitive deficits can 'live well' with pathology. Future data from non-pharmacological interventions, with a larger sample and a longer follow-up period, could confirm the results and the possible implications for such prevention strategies for early cognitive decline.

The purpose of this study is to explore the role of caregiver background, stressors, and resources for Mexican American caregiver turnover and depressive symptoms. Using two waves of the Hispanic Established Epidemiologic Study of the Elderly Caregiver Supplement (H-EPESE CG, 2010/2011-2016 N=333) and informed by the sociocultural caregiver stress process model, we estimate logistic and OLS regressions of caregiver turnover and caregiver depressive symptoms over five years. Neuropsychiatric expressions of dementia were significantly associated with caregiver turnover and relative to caregivers who were adult children of the care recipient, grandchildren caregivers and other kin and non-kin caregivers were more likely to experience caregiver turnover. While depressive symptoms were relatively low at both waves, there was a greater increase in depressive symptoms for caregivers who completed the interview in Spanish, which was partially explained by lower caregiver resources (e.g., support from others). The findings demonstrate the need for dementia care supports for Mexican American caregivers, improving support systems for Spanish-speaking caregivers, and supporting Mexican American caregivers who may be entering the role unexpectedly (e.g., grandchildren or non-kin).

The progression of Alzheimer’s disease (AD) and its interaction with COVID-19-induced social isolation remains poorly understood. This study investigated the longitudinal trajectories of AD severity on cognitive function, functional ability, and neuropsychiatric symptoms, and examined the impact of COVID-19 lockdown on AD patients in South Korea. In this retrospective longitudinal study, data from 253 adults (aged ≥ 55) diagnosed with mild cognitive impairment (MCI) or AD were analyzed, collected between 2018 and 2022. Participants were classified into four groups based on clinical dementia rating (CDR) scores: MCI, AD-CDR0.5, AD-CDR1, and AD-CDR2. Cognitive function, functional abilities, neuropsychiatric symptoms, depressive symptoms, and overall dementia severity were assessed. Linear mixed-effects models, along with mediation and moderation analyses were employed to analyze the data. Significant trajectories of decline in cognitive function and functional abilities were observed over time, with more pronounced declines in higher AD severity groups. The COVID-19 lockdown exacerbated cognitive decline and impairment in activities of daily living (ADL) specifically in the most severe AD group (AD-CDR2). Instrumental activities of daily living (IADL) mediated the relationship between mini-mental state examination (MMSE) scores and CDR sum of boxes (CDR-SB) in the MCI, AD-CDR0.5, and AD-CDR1 groups. A significant interaction between MMSE scores and neuropsychiatric symptoms was observed in the moderate AD group (AD-CDR1), indicating that worsening neuropsychiatric symptoms intensified cognitive decline. Neuropsychiatric Inventory (NPI) scores increased over time, indicating worsening neuropsychiatric symptoms, whereas depressive symptoms, measured by the short geriatric depression scale (SGDS), remained stable over the study period. This study highlights the impact of AD severity on cognitive and functional decline, further exacerbated by the COVID-19 lockdown. The mediating role of IADL suggests that maintaining complex daily activities may be crucial in slowing disease progression in AD patients. Additionally, the worsening of neuropsychiatric symptoms underscores the need for targeted mental health support, especially during periods of social isolation, to mitigate adverse effects on patients and caregivers.