Caregiver burden is increased in Parkinson\u2019s disease with mild cognitive impairment (PD-MCI)

Ann J Jones,Toni Pitcher,Daniel Myall,Kyla Horne,Paul T Barrett,Michael Macaskill,Tim J Anderson,John C Dalrymple-Alford,Roeline G Kuijer,Leslie Livingston

doi:10.1186/s40035-017-0085-5

Abstract

BackgroundThere is limited evidence on caregiver outcomes associated with mild cognitive impairment in patients with Parkinson’s disease (PD-MCI) and the coping strategies used by these caregivers.MethodsTo investigate this relationship, we examined levels of burden, depression, anxiety, coping strategies and positive aspects of caregiving in the informal caregivers of 96 PD patients. The PD patients were classified using MDS-Task Force Level II criteria as showing either normal cognition (PD-N; n = 51), PD-MCI (n = 30) or with dementia (PDD; n = 15).ResultsMean Zarit Burden Interview (ZBI) score increased significantly between carers of PD-N (M = 13.39, SD = 12.22) compared to those of PD-MCI patients (M = 22.00, SD = 10.8), and between carers of PD-MCI and PDD patients (M = 29.33, SD = 9.59). Moreover, the proportion of carers showing clinically significant levels of burden (ZBI score ≥ 21) also increased as the patients’ cognitive status declined (18% for PD-N; 60% for PD-MCI; and 80% for PDD) and was mirrored by an increasing amount of time spent providing care by the caregivers. Caregiver ZBI score was independent of patient neuropsychiatric symptoms, motor function, disease duration and time that caregivers spent caregiving. Caregiver use of different coping strategies increased with worsening cognition. However, we found only equivocal evidence that the use of problem-focused, emotion-focused and dysfunctional coping mediated the association between patient cognitive status and caregiver burden, because the inverse models that used caregiver burden as the mediator were also significant.ConclusionsThe study highlights the impact of Parkinson’s disease on those providing care when the patient’s cognition is poor, including those with MCI. Caregiver well-being has important implications for caregiver support, nursing home placement and disease course.

Highlights

There is limited evidence on caregiver outcomes associated with mild cognitive impairment in patients with Parkinson’s disease (PD-MCI) and the coping strategies used by these caregivers
Such results contrast with reports of increased caregiver burden in carers of people with MCI who are at risk of Alzheimer’s dementia [11], additional factors may contribute to PD caregiver difficulties [12]
We have found that specific Level II criteria, in which two impairments are required within a single domain, capture PD-MCI patients who are at greatest risk of decline to Parkinson’s disease because dementia (PDD) in the subsequent 4 years [4] and who may pose a greater challenge to caregiver well-being

Summary

Introduction

There is limited evidence on caregiver outcomes associated with mild cognitive impairment in patients with Parkinson’s disease (PD-MCI) and the coping strategies used by these caregivers. Recent assessments of well-being in PD-MCI caregivers has revealed mixed results, in that reduced quality of life measures were found in these caregivers [8] but explicit measures of burden using the Zarit Burden Interview (ZBI), did not show elevated levels of burden for PDMCI caregivers as compared to PD-N caregivers [9, 10]. Such results contrast with reports of increased caregiver burden in carers of people with MCI who are at risk of Alzheimer’s dementia [11], additional factors may contribute to PD caregiver difficulties [12]. We examined caregiver coping strategies and positive aspects of caregiving as potential mediators of the relationship between patients’ cognitive status and caregiver burden

Methods

Results

Discussion

Conclusion