title: The differential impact of unique behavioral and psychological symptoms for the dementia caregiver: how and why do patients' individual symptom clusters impact caregiver depressive symptoms?
abstract: OBJECTIVE
  The behavioral and psychological symptoms associated with dementia (BPSD) are highly burdensome to caregivers. While BPSD consist of a wide variety of patient behaviors including depression, physical aggression, and paranoid delusions, it remains unclear whether specific symptoms have a differential impact on caregivers. The aims of this study were 1) to assess how individual BPSD, categorized based on how they may affect caregivers, impact depressive symptoms for dementia patient caregivers and 2) to test the pathways by which BPSD clusters impact caregiver depressive symptoms.
  
  
  METHODS
  Cross-sectional analysis of data from a longitudinal study of patients with Alzheimer disease and dementia with Lewy bodies.
  
  
  METHODS
  Multiple U.S. dementia clinics.
  
  
  METHODS
  One hundred sixty patient-caregiver dyads.
  
  
  METHODS
  Using multivariate generalized estimating equation logistic models, we analyzed the relationship between four BPSD clusters (patient depressive symptoms, accusatory/aggressive behaviors, nonthreatening psychotic symptoms, and difficult to manage behaviors) and caregiver depressive symptoms and assessed mediators of these relationships.
  
  
  RESULTS
  Only the presence of patient depressive symptoms was associated with caregiver depression (odds ratio: 1.55; 95% confidence interval: 1.14-2.1). This relationship was mediated by caregiver report of both the symptom's impact on the patient and perceived burden to caregivers.
  
  
  CONCLUSIONS
  Patient depressive symptoms may be the most important driver of the relationship between BPSD and caregiver depression. Research in this field should further test the effects of individual BPSD and also consider how symptoms may negatively impact caregivers by increasing burden and evoking empathy for the patient.
authors.affiliation: Geriatrics Department, The Mount Sinai School of Medicine, New York, NY. Electronic address: Katherine.ornstein@mssm.edu.
authors.forename: Katherine
authors.initials: K
authors.lastname: Ornstein
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Gaugler
authors.forename: D P
authors.initials: DP
authors.lastname: Devanand
authors.forename: Nikos
authors.initials: N
authors.lastname: Scarmeas
authors.forename: Carolyn
authors.initials: C
authors.lastname: Zhu
authors.forename: Yaakov
authors.initials: Y
authors.lastname: Stern
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000374:Aggression / Q000523:psychology; D000544:Alzheimer Disease / Q000451:nursing* / Q000523:psychology; D017028:Caregivers / Q000523:psychology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003702:Delusions / Q000523:psychology; D003863:Depression / Q000523:psychology*; D005260:Female; D006801:Humans; D020961:Lewy Body Disease / Q000451:nursing* / Q000523:psychology; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011446:Prospective Studies; D011788:Quality of Life
keywords: Alzheimer dementia; BPSD; caregiver depression