Objective: To assess the association between the quality of the marital relationship and behavioral disturbances in the patient (mood/apathy problems, hyperactivity and psychosis).
Design: The Maastricht study of behavior in dementia (abbreviated as MAASBED) focuses on the course and risk factors of behavioral and psychological symptoms of dementia (BPSD). The project is a two-year follow-up study including 199 patients with dementia as well as 119 informal caregivers. MAASBED consists of two parts: part 1 focuses on predictors of BPSD in the patient, and part 2 examines the relationship between BPSD and characteristics of the caregiver.
Materials and Methods: This study focuses on the baseline results of 53 spousal dyads. Quantitative and qualitative methods were used to examine caregivers' perception of changes in the quality of the relationship. Behavioral disturbances in the patient were measured by the Neuro Psychiatric Inventory (NPI).
Results: Regression analysis of the baseline data revealed that behavioral problems are associated with deterioration of the relationship quality (p=0.001), but not with cognitive status (p=0.508) or functional impairment (p=0.832) of the patient. The mood/apathy sub-syndrome was a significant predictor of negative relationship change (p=0.010), whereas hyperactivity (p=0.151) and psychosis (p=0.457) were not. Analysis of the qualitative data of a subsample revealed that patient apathy rather than depressive mood was associated with negative relationship changes. Apathy diminished the interaction between partners (e.g. communication, joint activities, reciprocity).
Conclusion: The hypothesis that relationship changes are associated with BPSD was supported. Salient is that these behavioral symptoms are associated with deterioration of the marital relationship independent of cognitive problems or functional impairment. Caregivers who mentioned mood symptoms in the patient, particularly apathy, reported more changes in the marital relationship. These findings suggest that deficits in behavior of the patient (apathy) have more impact on deterioration of the marital relationship than excesses in behavior. However, there may be a bi-directional pattern of causation. Marital distress may cause subsequent increase in behavioral problems in the patient. This will be verified in the follow up.
MAASBED was funded by the Dutch Research Council (NWO; number 940 33 039)
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