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Cited by 71Dementia and Cognitive Impairment ResearchNursing care and researchFamily Caregiving in Mental Illness

Relationship between the number of behavioral symptoms in dementia and caregiver distress: what is the tipping point?

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Arthur, Paul B., Gitlin, Laura N., Kairalla, John A., Mann, William C.·2018·International Psychogeriatrics
DOI 10.1017/s104161021700237xPMC PMC7103581
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Abstract

ABSTRACTBackground:Behavioral and psychological symptoms of dementia (BPSD) are a primary manifestation of brain dysfunction in dementia and a great challenge in caregiving. While BPSD are historically associated with caregiver distress, it is unclear whether there is an identifiable point where BPSD number is associated with heightened caregiver distress. The purpose of this study was to determine if such a tipping point exists to assist clinicians in identifying caregiver compromise. METHODS: Analyses were performed with three datasets totaling 569 community-dwelling persons with dementia and their caregivers. Each included identical demographic, BPSD, cognitive, and caregiver well-being measures. Linear regression was performed with 16 BPSD symptoms on caregiver well-being measures and predictive values determined with receiver operating characteristic (ROC) curves and pre-defined scores for clinically significant distress. RESULTS: Of the 569 persons with dementia, 549 (96%) displayed at least one BPSD, mean of 5.7 (SD = 3.06) symptoms in the past month. After controlling for covariates, BPSD symptom number was significantly associated with caregiver depression and burden (p < 0.01 for both models). Findings indicate ≥ 4 BPSD has strong predictive values for depression (sensitivity 85%, specificity 44%, area under ROC curve 0.62, p < 0.01), and burden (sensitivity 84%, specificity 43%, area under ROC curve 0.67, p < 0.01). CONCLUSIONS: Caring for persons with four or more BPSD appears to reflect a tipping point for clinically meaningful distress. Findings have implications for clinicians working with persons with dementia and their caregivers and suggest need for continuous monitoring of BPSD and identification of at risk caregivers.

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  • Caring for people with dementia who have four or more behavioral and psychological symptoms represents a tipping point, as these caregivers are more likely to report clinically meaningful depression and burden.

    “Caring for people with dementia who have four or more behavioral and psychological symptoms (for example, aggression, self-harm and wandering) represents a”

    From 2023 Alzheimer's disease facts and figures (2023) · cites this paper as [487]

  • Caring for people with dementia who have four or more behavioral and psychological symptoms represents a "tipping point," as these caregivers are more likely to report clinically meaningful depression and burden.

    “Caring for people with dementia who have four or more behavioral and psychological symptoms (for example, aggression, self‐harm and wandering) represents a “tipping point,” as these caregivers are more likely to report clinically meaningful depression and burden. 532”

    From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [532]

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Authors
Arthur, P. B., Gitlin, L. N., Kairalla, J. A., & Mann, W. C.
Affiliations
  • St. Catherine University (US)
  • Johns Hopkins University (US)
  • University of Florida (US)
Corresponding author
Arthur, Paul B.
ORCID
Venue
International Psychogeriatrics
Publisher
Elsevier BV
Published
2018-08
Volume
30
Issue
8
Pages
1099-1107
ISSN
1041-6102 (ISSN-L)
DOI
10.1017/s104161021700237x
PMC
PMC7103581
OpenAlex
W2769142775
Cited by
71
References
32
Citations by year
2026: 8 · 2025: 11 · 2024: 7 · 2023: 9 · 2022: 11 · 2021: 11 · 2020: 5 · 2019: 7 · 2018: 2
FWCI
3.14
Type
journal article
Language
en
Open access
Licence
Locations
  • International Psychogeriatrics (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute of Mental Health (R01AG041781, R01AG049692, P30AG048773, R21MH069425)
  • National Institute on Aging
  • University of Florida
  • National Institute of Nursing Research (R01AG22254, 2401000272)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Health Professions › Pharmacy › Nursing care and research
  • Social Sciences › Psychology › Clinical Psychology › Family Caregiving in Mental Illness
Keywords
behavioral and psychological symptoms of dementia, caregiver distress, caregiver burden, caregiver depression, tipping points, symptom count, caregiver well-being
MeSH terms
Adult, Aged, Aged, 80 and over, Behavioral Symptoms, Dementia, Depression, Female, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Quality of Life, ROC Curve, Sensitivity and Specificity, United States, Linear Models, Caregivers, Independent Living

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