Anger in family caregivers of people with behavioral variant frontotemporal dementia versus Alzheimer’s disease

Abstract

AbstractBackgroundAmple evidence exists that family caregivers of a person with dementia (PWD) suffer a disproportionate level of burden, stress, and strain compared to non‐caregiving individuals. Less is known about the specific negative emotions experienced by dementia caregivers, such as anger. Anger is experienced by 40‐60% of dementia family caregivers and is associated with feelings of resentment towards the PWD. Anger may mediate aspects of caregiver well‐being and the quality of care of the PWD. Caregivers may experience increased anger due to behavioral symptoms of the PWD, but this has not been well‐characterized. Frontotemporal dementia (FTD), particularly the behavioral variant (bvFTD), is characterized primarily by behavioral symptoms. In contrast, cognitive symptoms may be more prominent in Alzheimer’s Disease (AD). We examined anger ratings of family caregivers for PWDs diagnosed with bvFTD, the two other FTD subtypes (i.e., semantic variant primary progressive aphasia [svPPA], and non‐fluent variant primary progressive aphasia [nfvPPA]), and AD.MethodWe studied 48 familial PWD‐caregiver dyads (19 bvFTD, 9 svPPA, 8 nfvPPA, 12 AD). PWD behavioral symptoms were assessed using the Neuropsychiatric Inventory (NPI). PWD cognitive symptoms were assessed using the Mini‐Mental State Examination (MMSE). Caregivers self‐reported their anger on the State Anger Scale.ResultAn ANOVA revealed that caregivers of people with bvFTD, svPPA, nfvPPA, and AD differed in anger (F=3.22; p=.03). Posthoc analyses revealed that bvFTD caregivers reported greater anger (M=1.50, SD=.46) than AD caregivers (M=1.18, SD=.21, p=.02). No other group difference was found. Follow‐up analyses revealed that within bvFTD and AD caregivers, higher caregiver anger was associated with higher scores on the NPI reflecting greater PWD behavioral symptoms (r =.63, p<.001), but not cognitive functioning on the MMSE (r=‐.03, p=.85). Importantly, PWD behavioral symptoms fully mediated the association between disease diagnosis (i.e., bvFTD vs. AD) and caregiver anger. We did not find a similar mediation effect for PWD cognitive functioning.ConclusionAnger among family caregivers is higher among those caring for persons with bvFTD compared to AD. Our findings reveal the important role that behavioral symptoms in PWDs play in explaining caregiver anger.