Multidimensional factors of family caregiver burden in Alzheimer's disease

Introduction: The care burden of patients with Alzheimer’s disease is largely put on their families. The relative caregivers are under a great deal of stress and, consequently, they often show depression, insomnia, antisocial behavior and a general worsening in the quality of life (Ryu et al., 2011). Objective: The present study evaluated which behavioral disturbances are the major cause of stress for the caregivers of patients with Alzheimer’s disease. Caregivers more often are sons and daughters (60.2%) and spouses (32.5%), mean age 56.8 ± 13.5. Women represent the greatest percentage of caregivers (74.7%), significantly younger of men (p < 0.01), more often housewifes (p < 0.05), able to spend more hours during the day to take care of their own relative; in comparison to men (p < 0.001). However, mean stress load, measured with (CBI) scale, wasn’t significantly different between the two sexes. Patients: Patients were 177 women (61.3%) and 112 men (38.7%), mean age 74.4 ± 3.9. The 56.4% of the sample has a moderate to severe impairment, and 15.9% a slight impairment. The mean score in ADL scale is 3.0 ± 1.9, and in IADL scale is 3.3 ± 2.4. No statistically significant difference was found in all the clinical scales, between the two sexes. Results: In patients the most frequent neuropsychiatric symptoms are anxiety (80%), sleeplessness (78.2%), agitation and depression (74.4% for each one). The strongest correlations between CBI scores and clinical scales (MMSE, ADL, IADL) are with the three first burdens (objective, developmental, physical), while the other two are slightly related. Instead there is a slight correlation between CBI and NPI scales (r = 0.4; p < 0.001). In great detail, the strongest correlations of CBI were found with sleep (r = 0.47), motor activity (r = 0.46), disinhibition (r = 0.41), delirium (r = 0.36), hallucinations (r = 0.29). Discussion: Analyzing the impact of neuropsychiatric symptoms on the scores of each CBI burden, we note that sleep, euphoria and disinhibition are the most important on the objective burden; sleep, hunger and delirium on the developmental burden. Though weakly, scores of clinical scales are related to global score of NPI. In particular, correlation is r = -0.26 (p < 0.001) between NPI and MMSE, r = -0.39 (p < 0.001) between NPI and ADL, r = -0.33 (p < 0.001) between NPI and IADL. Daily hours of care strongly correlate with the scores of clinical tests (MMSE, ADL, IADL) and with stress load, measured by CBI. Particularly, they correlate with the objective (r = 0.76), the developmental (r = 0.62) and the physical burdens (r = 0.63). Conclusion: Behavioural disorders severely affect the quality of life of the patients and their families, resulting in the patients’ hospitalisation (Feldman H. 2000). Psychoeducation and support for caregivers can educate them about resources and by teaching specific problem solving and coping techniques (Toseland& Smith, 2001).