Troublesome symptoms that accompany dementia - 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.
"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.