title: Are there sensitive time periods for dementia caregivers? The occurrence of behavioral and psychological symptoms in the early stages of dementia.
abstract: BACKGROUND
  The behavioral and psychological symptoms associated with dementia (BPSD) can be burdensome to informal/family caregivers, negatively affecting mental health and expediting the institutionalization of patients. Because the dementia patient-caregiver relationship extends over long periods of time, it is useful to examine how BPSD impact caregiver depressive symptoms at varied stages of illness. The goal of this study was to assess the association of BPSD that occur during early stage dementia with subsequent caregiver depressive symptoms.
  
  
  METHODS
  Patients were followed from the early stages of dementia every six months for up to 12 years or until death (n = 160). Caregiver symptoms were assessed on average 4.5 years following patient's early dementia behaviors. A generalized estimating equation (GEE) extension of the logistic regression model was used to determine the association between informal caregiver depressive symptoms and BPSD symptoms that occurred at the earliest stages dementia, including those persistent during the first year of dementia diagnosis.
  
  
  RESULTS
  BPSD were common in early dementia. None of the individual symptoms observed during the first year of early stage dementia significantly impacted subsequent caregiver depressive symptoms. Only patient agitation/aggression was associated with subsequent caregiver depressive symptoms (OR = 1.76; 95% CI = 1.04-2.97) after controlling for concurrent BPSD, although not in fully adjusted models.
  
  
  CONCLUSIONS
  Persistent agitation/aggression early in dementia diagnosis may be associated with subsequent depressive symptoms in caregivers. Future longitudinal analyses of the dementia caregiving relationship should continue to examine the negative impact of persistent agitation/aggression in the diagnosis of early stage dementia on caregivers.
authors.affiliation: Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA. katherine.ornstein@mssm.edu
authors.forename: K A
authors.initials: KA
authors.lastname: Ornstein
authors.forename: J E
authors.initials: JE
authors.lastname: Gaugler
authors.forename: D P
authors.initials: DP
authors.lastname: Devanand
authors.forename: N
authors.initials: N
authors.lastname: Scarmeas
authors.forename: C W
authors.initials: CW
authors.lastname: Zhu
authors.forename: Y
authors.initials: Y
authors.lastname: Stern
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001526:Behavioral Symptoms / Q000175:diagnosis* / Q000209:etiology; D017028:Caregivers / Q000523:psychology*; D017281:Cost of Illness; D003702:Delusions / Q000175:diagnosis* / Q000209:etiology; D003704:Dementia / Q000150:complications / Q000451:nursing / Q000523:psychology*; D003863:Depression / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D006801:Humans; D007508:Irritable Mood; D008297:Male; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011595:Psychomotor Agitation / Q000209:etiology; D012044:Regression Analysis; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000523:psychology; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States