title: Factors associated with increased caregivers' burden in several cognitive stages of Alzheimer's disease.
abstract: OBJECTIVE
  To investigate factors associated with caregiver burden (CB) in persons caring for older adults with various cognitive stages of Alzheimer's disease (AD).
  
  
  METHODS
  Participants were 1127 outpatients and their caregivers. Participants comprised 120 older adults with normal cognition (NC), 126 with amnestic mild cognitive impairment (aMCI) and 881 with AD. AD patients were subclassified into four groups by Mini-Mental State Examination (MMSE) score: AD29-24 (n = 117), AD23-18 (n = 423), AD17-12 (n = 254) and AD11-0 (n = 87). Participants and their caregivers underwent comprehensive geriatric assessment batteries including Zarit Burden Interview (ZBI) Barthel Index, Lawton Index, Dementia Behavior Disturbance Scale (DBD) to evaluate CB, Instrumental and Basic Activity of Daily Living (IADL/BADL), and Behavioral and Psychological Symptoms of Dementia (BPSD). The comorbidity of geriatric syndrome and the living situation of the patient/caregiver were also assessed.
  
  
  RESULTS
  ZBI score was higher in patients with lower MMSE score. Multivariate regression analysis identified that DBD was consistently associated with CB in all patients; symptoms related to memory deficit were related to CB in aMCI; differential IADL, such as inability to use a telephone, use transportation, manage finances, shop, cook and take responsibility for own medication, were related to CB in AD29-24, AD23-18 and AD17-12, and geriatric syndrome including falls and motor disturbance, sleep problems, urinary incontinence, and fatigue was related to CB in AD23-18 and AD17-12.
  
  
  CONCLUSIONS
  Multiple factors including BPSD, impaired life function and geriatric syndrome were cognitive stage-dependently associated with CB. Preventive treatment of BPSD and comorbidity, and effective assistance for IADL deficits could contribute to alleviation of CB.
authors.affiliation: Center for Comprehensive Care and Research on Memory Disorders; Department of Rehabilitation, National Center for Geriatrics and Gerontology, Obu.
authors.forename: Masaki
authors.initials: M
authors.lastname: Kamiya
authors.forename: Takashi
authors.initials: T
authors.lastname: Sakurai
authors.forename: Noriko
authors.initials: N
authors.lastname: Ogama
authors.forename: Yohko
authors.initials: Y
authors.lastname: Maki
authors.forename: Kenji
authors.initials: K
authors.lastname: Toba
mesh_terms: D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000523:psychology / Q000534:rehabilitation*; D002055:Burnout, Professional / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D017028:Caregivers / Q000523:psychology*; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
keywords: Alzheimer's disease; activity of daily living; behavioral and psychological symptoms of dementia; caregivers' burden; geriatric syndrome