Objective: To determine the prevalence and impact of neuropsychiatric symptoms of dementia on family and professional caregivers.
Design: Patients with a first time diagnosis of dementia were recruited from the outpatient clinics and acute psychogeriatric wards. They were assessed using the Neuropsychiatric Inventory with Caregiver Distress Scale (NPI-D). The professional caregivers consisting of our regular nurses were interviewed using the NPI-NH version after the third day of admission. The questions were rephrased to assess the 'occupational disruptiveness of the behaviors. The Chinese Mini-Mental State Examination (CMMSE) was used as a measure of the cognitive status.
Materials and Methods: All statistical analyses were carried out using SPSS (version 11.0). Associations with categorical variables were assessed using Chi-square or Fisher’s exact tests. Two sample t-test was performed if the normal distribution assumption was satisfied. A stepwise multivariate regression analysis was performed on the total distress score and NPI score of all the neuropsychiatric symptoms.
Results: 85 consecutive patients were recruited. A majority were Chinese (84.7%) with the main family caregiver being the spouse (32.9%), followed by daughters (18.8%). 49% (n=42) were managed as inpatients and 51% (n=43) as outpatients. The mean duration of illness before their first presentation was 32.3 months. Performing a logistics regression analysis on the admission of these patients, only the aberrant motor symptoms were a significant predictor; patients with aberrant motor symptoms were less likely to be admitted. The median NPI score for agitation and disinhibition domains were significantly higher in the inpatient group. Neuropsychiatric symptoms were reported in as high as 86% of patients taken care of by family caregivers and 78% of patients in the professional caregiver group. The mean total distress score of family carers was significantly higher. Our family carers had experienced more distress caring for the male dementia sufferers. Distress reported by the family caregivers was systematically higher across all domains; they were significantly more distressed over the delusion, agitation, depression and aberrant motor domains. However, the severity of the reported behavioral disturbances as assessed by the NPI was not significantly higher. Conversely, although less distressed by the neuropsychiatric symptoms, the nurses tended to score higher in the severity rating with regard to the euphoria and disinhibition domains.
Conclusion: Neuropsychiatric symptoms were found to be common and were positively correlated with distress amongst the caregivers but cognitive status was not predictive of distress. Family caregivers were significantly more distressed than the professional caregivers. The difficulty of family carers in caring for the male demented elderly could be explained by the status of the male figure in Asian families. The expected submissive role of the female family caregiver would pose great tension and conflicts in situations where the difficult neuropsychiatric disturbances required necessary firm handling.
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