Examining Environmental Predictors of Behavioral Symptoms of Dementia Using Dynamic Structural Equation Modelling

Abstract

AbstractBackgroundMost persons with Alzheimer’s disease and related dementias (ADRD) experience behavioral symptoms as a result of exposure to stressors in the environment. Daily diaries can capture fluctuations in behavioral symptoms in response to environmental stressors. The purpose of this multi‐time series longitudinal study was to determine whether potential protective factors, caregiver reciprocity and a shared activity were associated with the number of behavioral symptoms person with ADRD.MethodA community‐dwelling sample of 453 caregivers for persons with ADRD (age 18+) completed 21 days of once‐a‐day diary surveys. Caregiver perceived reciprocity was assessed using a question asking, “How satisfied were you with amount of affection or appreciation your relative with dementia showed towards you?” Responses were coded using a Likert scale with 1‐Not at all and 5‐Very much. Caregivers were asked whether they did a pleasant non‐care activity with their relative and about a presence of eight different behavioral symptoms in persons with ADRD. We used a two‐level dynamic structural equation model to examine the relationship between the number of different behavioral symptoms, caregiver reciprocity and a shared activity on a given day, and the following day.ResultCaregivers completed 7,783 diaries. Caregivers were mostly female (87.4%), non‐Hispanic white (51.4%) with a mean age of 53 years (SD = 14) caring for a parent/parent‐in‐law/stepparent (61.5%) with a mean age of 79 years (SD = 9). Caregiver perceived reciprocity had a significant direct effect on the number of behavioral symptoms experienced the same day and the next day. While no significant main or cross‐lagged effects were found between shared activity and behavioral symptoms, estimates suggest the impact was negligible (0.7% increase).ConclusionWe found that caregiver perceived reciprocity may reduce the number of behavioral symptoms a person with ADRD has that day and the following day. These findings support the growing body of theoretical and empirical work suggesting caregivers are an important feature of the environment and influence behavioral symptom presentation.