Caregiver burden predicting factors in Alzheimer's disease

Introduction: In our country, the patients domiciliar “take-care system” is based firstly on the family support together with the supply of health care providers and home care professionals provided by the National Health System. Caregivers of Alzheimer's disease (AD) patients are usually subjected to enormous physical and mental stress, as well as emotional, which may have repercussions on personal, familiar and social contest and, consequently, on life’s quality. (Ryu et al., 2011). The aim of our study was to investigate if behavioral and psychological symptoms could be considered as caregivers burden “predicting factors”. Materials and methods: We enrolled 289 patients’ caregivers of (61.2% F) (38.8% M), mean age 74.46 years, mean M.M.S.E: 14.96, mean Clinical Dementia Rating Scale 1.88, mean ADL 3.02, mean IADL 3.33, that practised a regoular follow up at our Dementia Center. We considered one caregiver for patient, with no sex difference (women 74.7%, men 25.3%). As regards the familiar role, they were mainly sons (60.2%) and spouses (32.5%). Mean age was 56.8 ± 13.5 and the educational years level was very low (mean 9.3 ± 3.9). They dedicated an average of 11.6 ± 6.3 hours per day to care for a family member. 77.5% of caregivers live at home, more often housewives 52.9%. Inclusion criteria were: age> 50 years, diagnosis of probable AD according to the NINCS-ADRDA criteria (McKhann et al., 1984); on the other hand we considered as exclusion criteria a previous stroke and / or brain trauma, co-morbidity with neurological or psychiatric diseases, co-existence of severe internal diseases, history of alcohol and / or drug abuse. All patients underwent an extensive anamnestic, neuroradiological, neurological and cognitive screening. The caregivers were submitted to an extensive evaluation using Clinical Dementia Rating Scale, Caregiver Burden Inventory, Neuropsychiatic Inventory. Results: Caregivers examinations showed a high perception of the care load, in particular: load time (11.35 ± 6.94), evolutionary load (11.51 ± 5.56), physical load (9.32 ± 5.07), social load (5.86 ± 5.43), emotional load (2.89 ± 3.26). Moreover, sleep disorders, anxiety and agitation were the most represented behavioral disorders and, consequentely, the greatest cause of stress for relatives (75.4%, 75.1% and 74% respectively) Discussion and conclusions: The objective and evolutionary load were related to disinhibition, motor activity and sleep patients disordes; the social load was related to delusions and sleep disordes, instead the emotional one was related to delusions, hallucinations, disinhibition, irritability, motor activity and sleep disorders. The caregivers stress was influenced by all five dimensions of the CBI, but the objective load seemed to be the most relevant. In the end, we can conclude that the age and the hours of assistance and care, in this study, may be significant predictors of the caregivers burden.