Patients With Dementia Research Articles

Comparison of on Site versus Online Psycho Education Groups and Reducing Caregiver Burden

ABSTRACT Objectives The purpose of this project was to comparatively assess the benefit from the effects of the online versus onsite psychoeducative interventions on caregivers’ emotional burden, including their sense of burden, anxiety, and depression. Methods Seventy-one caregivers of Patients with Dementia (PwD) were divided in two groups, the online versus the onsite, and participated in the 4-month psychoeducational group intervention. Psychosocial assessment was performed using Beck Anxiety Inventory, Beck Depression Inventory and Zarit Burden Interview before and after the intervention. Results No significant differences were found between the online and onsite groups in anxiety (p = .531), depression (p = .577) and sense of burden (p = .623) after the interventions. Both interventions showed significant reductions across emotional variables measured over the course of the treatment study and treatment interventions. Conclusions Both online and onsite interventions are effective at improving emotional health as they reduce the level of anxiety, depression, and sense of caregiver burden. Clinical implications The use of online psychoeducative interventions is indicative for use by clinicians who work with dementia caregivers as compared to the onsite ones. Therefore, they may be assumed as having significant utility in dementia caregivers, especially when being adapted during the recent confinement measures due to the coronavirus disease pandemic (COVID-19).

Healthcare Utilization in Different Stages among Patients with Dementia: A Nationwide Population-Based Study.

To evaluate the trend of healthcare utilization among patients with dementia (PwD) in different post-diagnosis periods, Taiwan’s nationwide population database was used in this study. PwD were identified on the basis of dementia diagnoses during 2002–2011. We further subdivided the cases into 10 groups from the index year to the 10th year after diagnosis. The frequency of emergency department visits and hospitalizations, the length of stay, outpatient and department visits, and the number of medications used were retrieved. The Joinpoint regression approach was used to estimate the annual percent change (APC) of healthcare utilization. The overall trend of healthcare utilization increased with the progression of dementia, with a significant APC during the first to second year after diagnosis (p < 0.01), except that the frequency of outpatient visits showed a decreasing trend with a significant APC from the first to fifth year. All sex- and age-stratified analyses revealed that male gender and old age contributed to greater use of healthcare services but did not change the overall trend. This study provides a better understanding of medical resource utilization across the full spectrum of dementia, which can allow policymakers, physicians, and caregivers to devise better care plans for PwD.

Missed Nursing Care Among Patients With Dementia During Hospitalization: An Observation Study.

Patients with dementia (PwD) are characterized as a vulnerable group as they are unable to communicate their needs, putting them at risk for care omissions. The current study aimed to explore care toward PwD and detect if any aspects of care are omitted. An observation study was conducted in three medical-surgical adult wards of an acute general hospital. Data were collected by an observer, through field notes, and were analyzed with content analysis. A face scale was used to assess PwD's mood. Thirteen PwD were observed for 90 hours. Four thematic areas were identified: (a) Unmet Fundamental Patient Needs, (b) Human Right to Dignity and Respect, (c) Communication Deficiencies, and (d) Implementation of Nursing Interventions. Nurse-patient contact lasted from 5 to 7 minutes and numerous care omissions were noted. The face scale assessment revealed that most PwD looked very sad after nursing care. This study enriches insight for the care of PwD during hospitalization and emphasizes the need for health care workers' education and support. [Research in Gerontological Nursing, 14(3), 150-159.].

Recruiting general practitioners and patients with dementia into a cluster randomised controlled trial: strategies, barriers and facilitators

BackgroundRecruitment of general practitioners (GPs) and their patients is reported as one of the most challenging steps when undertaking primary care research. The present paper describes the recruitment process of a cluster randomised controlled trial (cRCT) aiming to improve dementia care in the primary care setting.MethodsRecruitment data was analysed descriptively using frequency tables to investigate comparisons of recruitment rates and results of different recruitment strategies as well as reasons for participation and non-participation of GPs, patients with dementia (PwD) and their caregivers.ResultsOver a period of 23 months, N = 28 GPs were successfully included in the cRCT. This represents an overall recruitment rate of 4.6%. The most efficient strategy in terms of high response and low labour-intensity involved the dissemination of calls for participation in a GP research network. Most frequently reported reasons for GP’s participation were Improvement of patient’s well-being (n = 22, 79%) followed by Interest in dementia research (n = 18, 64%). The most common reasons for non-participation were Lack of time (n = 71, 34%) followed by Not interested in participation (n = 63, 30%). On a patient level, N = 102 PwD were successfully recruited. On average, each GP referred about n = 7 PwD (range: 1–17; mdn = 6; IQR = 3.5) and successfully recruited about n = 4 PwD (range: 1–11; mdn = 3; IQR = 3.5).ConclusionFirst, our findings propose GP research networks as a promising strategy to promote recruitment and participation of GPs and their patients in research. Second, present findings highlight the importance of including GPs and their interests in specific research topics in early stages of research in order to ensure a successful recruitment. Finally, results do not support cold calls as a successful strategy in the recruitment of GPs.Trial registrationThe trial was prospectively registered with the ISRCTN registry (Trial registration number: ISRCTN15854413). Registered 01 April 2019.

The effects of caregiver characteristics on behavioral and psychological symptoms of dementia of patients with dementia

Objective To determine the association between caregiver characteristics and behavioral and psychological symptoms of dementia (BPSD) in patients with dementia (PWD) in a Taiwanese community-dwelling population. Methods This cross-sectional study was conducted using the data of 190 patients with Alzheimer’s disease/dementia and 190 informal matched caregivers in Taiwan. BPSD were examined using the Neuropsychiatric Inventory-Questionnaire (NPI-Q). Correlation and regression analyses were used to explore associations between caregiver characteristics and the presence, severity, and distress of NPI-Q items. Results Only spouse primary caregiver was positively associated with presence of delusions in PWD. Caregiver education was positively correlated to severity of hallucinations, agitation/aggression, and apathy/indifference in PWD, while child primary caregiver was positively related to severity of disinhibition in PWD but negatively related to severity of anxiety in PWD. Spouse primary caregiver was positively related to severity of anxiety and appetite/eating in PWD while sole primary caregiver was positively related to severity of anxiety and nighttime behaviors in PWD. Caregiver education was positively correlated to distress of agitation/aggression in caregivers while child primary caregiver was positively related to distress of disinhibition in caregivers. Spouse primary caregiver was positively related to distress of anxiety and appetite/eating in caregivers while spouse caregiver was positively related to distress of nighttime behaviors in caregivers. Conclusions Caregiver education, child and spouse primary caregiver were relevant to severity of PWD and distress of caregivers of BPSD. It is suggested that healthcare professionals provide caregivers with proper individualized interventions based on these results to enhance caring quality. Key points Caregiver education was positively correlated to severity of hallucinations, agitation/aggression, and apathy/indifference, and distress of agitation/aggression. Child primary caregiver was positively related to severity and distress of disinhibition but negatively related to severity of anxiety. Spouse primary caregiver was positively related to severity and distress of anxiety and appetite/eating, and distress of nighttime behaviors

Supporting GPs around euthanasia requests from people with dementia: a qualitative analysis of Dutch nominal group meetings.

BackgroundEuthanasia has been regulated by law under strict conditions in the Netherlands since 2002. Since then the number of euthanasia cases has constantly increased, and increased exponentially for patients with dementia (PWD). The number of euthanasia requests by such patients is even higher. Recently, an interview study showed that physicians who are confronted with a PWD’s euthanasia request experience problems with communication, pressure from relatives, patients, and society, workload, interpretation of the law, and ethical considerations. Moreover, if honoured, the physician and patient may interpret the right moment for euthanasia differently.AimTo identify ways of supporting GPs confronted with a PWD’s euthanasia request.Design and settingTwo expert nominal group meetings were organised with Dutch care physicians for older people, GPs, legal experts, a healthcare chaplain, a palliative care consultant, and a psychologist.MethodA total of 15 experts participated in the meetings. Both meetings were audio-recorded, transcribed verbatim, and analysed using thematic analysis.ResultsFour themes emerged from the meetings: support provided by healthcare professionals, influencing public opinion, educational activities, and managing time and work pressure. The need for support was considered highest for GPs for all of these themes.ConclusionConsensus was reached with the help of experts on support needs for GPs confronted with euthanasia requests from PWD. A concise and clear explanation of the law is strongly desired. Changing public opinion seems the most challenging and a long-term aim. Communication training for finding the right balance between the physician’s professional responsibility and the patient’s autonomy should be made available, as a short-term aim.

Mismatch of Subjective and Objective Risk of Falling in Patients with Dementia

Match or mismatch of objective physiological and subjectively perceived fall risk may have serious consequences in patients with dementia (PwD) while research is lacking. To analyze mismatch of objective and subjective fall risk and associated factors in PwD. Cohort study in a geriatric rehabilitation center. Objective and subjective risk of falling were operationalized by Tinetti's Performance Oriented Mobility Assessment and the Falls Efficacy Scale-International. Four sub-groups according to objective and subjective fall risk were classified. Subgroups were compared for differences in clinical, cognitive, psychological, and behavioral variables. In geriatric rehab patients with mild to moderate dementia (n = 173), two-thirds showed a mismatch of subjective versus objective risk of falling, independently associated with previous falls. Underestimation of objective fall risk (37.6%) was determined by lower activity avoidance (OR 0.39), less concerns about falling due to previous falls (OR 0.25), and higher quality of life (OR 1.10), while overestimation (28.9%) was determined by higher rate of support seeking strategies (OR 50.3), activity avoidance (OR 15.2), better executive (OR 21.0) and memory functions (OR 21.5), and lower quality of life (OR.75) in multivariate logistic regression. The majority of patients showed a mismatch between objective and subjective falls risk. Underestimation as well as overestimation of fall risk was associated with specific profiles based on cognitive- and psychological status, falls and fall-related behavioral consequences which should be included in the comprehensive assessment of fall risk, and planning of individualized fall prevention programs for this population.

Specific Motor and Cognitive Performances Predict Falls during Ward-Based Geriatric Rehabilitation in Patients with Dementia.

The aim of this study was to identify in-hospital fall risk factors specific for multimorbid hospitalized geriatric patients with dementia (PwD) during hospitalization. Geriatric inpatients during ward-based rehabilitation (n = 102; 79.4% females; 82.82 (6.19) years of age; 20.26 (5.53) days of stay) were included in a comprehensive fall risk assessment combining established clinical measures, comprehensive cognitive testing including detailed cognitive sub-performances, and various instrumented motor capacity measures as well as prospective fall registration. A combination of unpaired t-tests, Mann–Whitney-U tests, and Chi-square tests between patients with (“in-hospital fallers”) and without an in-hospital fall (“in-hospital non-fallers”), univariate and multivariate regression analysis were used to explore the best set of independent correlates and to evaluate their predictive power. In-hospital fallers (n = 19; 18.63%) showed significantly lower verbal fluency and higher postural sway (p < 0.01 to 0.05). While established clinical measures failed in discriminative as well as predictive validity, specific cognitive sub-performances (verbal fluency, constructional praxis, p = 0.01 to 0.05) as well as specific instrumented balance parameters (sway area, sway path, and medio-lateral displacement, p < 0.01 to 0.03) significantly discriminated between fallers and non-fallers. Medio-lateral displacement and visuospatial ability were identified in multivariate regression as predictors of in-hospital falls and an index combining both variables yielded an accuracy of 85.1% for fall prediction. Results suggest that specific cognitive sub-performances and instrumented balance parameters show good discriminative validity and were specifically sensitive to predict falls during hospitalization in a multimorbid patient group with dementia and an overall high risk of falling. A sensitive clinical fall risk assessment strategy developed for this specific target group should include an index of selected balance parameters and specific variables of cognitive sub-performances.

A Systematic Review of Mindfulness-Based Interventions for Patients with Mild Cognitive Impairment or Dementia and Caregivers.

The aim of this article was to systematically review the quality and efficacy of the current evidence for mindfulness-based interventions (MBIs) in patients with mild cognitive impairment (MCI), patients with dementia (PwD), and their caregivers. We identified 20 randomized controlled trials (RCTs) (11 for patients, 9 for caregivers) published in the last 15 years. Evidence suggested that MBIs are highly acceptable and credible treatments for patients with MCI, PwD and caregivers. Specifically, for PwD, the results indicated that the magnitude of post-treatment effects of MBIs are in the medium to large range for psychosocial outcomes, and in the small to medium range for cognitive functioning; however, treatment effects on dementia biomarkers were mixed, ranging from small to large, depending on the outcome measure. Findings also evidenced salutary effects of MBIs for caregivers of PwD, with post-treatment effects ranging from medium to large for caregiver stress and burden and large effects for quality of life, and mixed outcomes for cognitive functioning, with effects in the small to large range. However, confidence in these findings is relatively limited due to methodological limitations, especially in terms of poor consistency in intervention strategies, outcome measures, and other key criteria across studies. To better assess the value of MBIs for these populations and optimize treatment outcomes, we recommend further research with improved study methodology (e.g., multi-method assessment, universal criterion and outcome measures, use of active control groups, larger sample sizes, long-term follow-up) to replicate current findings and enhance our understanding of underlying treatment mechanisms of MBIs.

Bouncing Back from the Burden of Dementia

Abstract. Background: Although there is mounting evidence of dyadic interdependencies between patients with dementia (PWD) and their caregivers, predictors of resilience among PWD and their caregivers are generally regarded in isolation. We therefore investigated how dyadic interdependencies regarding common resilience factors predict subjective notions of individual resilience. Methods: A total of 29 dyads (caregivers: 23 female, 73 ± 7 years; PWD: 6 female, 76 ± 6 years, Mini-Mental State Examination (MMSE) score: 18 ± 6) drawn from two studies answered questions about resilience (Brief Resilience Scale; BRS), partnership quality (Marital Quality Questionnaire; PFB), and depression (Geriatric Depression Scale; GDS-15). Using linear regression models, we predicted BRS scores by linearly combining individual characteristics (intraindividual level), characteristics of the partner (interindividual level), and their dyadic similarity (dyadic level). Results: Intraindividually, higher resilience in caregivers was associated with female sex; interindividually, it was associated with lower MMSE scores and higher PFB scores in PWD. On a dyadic level, the more different the GDS-15 scores were, the higher the resilience of caregivers. For PWD, higher resilience was significantly related to individual lower GDS-15 scores and higher PFB scores, while the characteristics of caregivers did not explain any variance. However, similarity in GDS-15 scores predicted higher resilience in PWD. Discussion: Resilience is affected differently in PWD and caregivers, potentially pointing to different strategies in coping with disease-related changes. Future studies are necessary to examine the mechanisms underlying resilience in PWD and their respective caregiver in order to tailor interventions that address the needs of both parties, from the individual, interindividual, and dyadic perspectives.

The Needs and Utilization of Long-Term Care Service Resources by Dementia Family Caregivers and the Affecting Factors.

This study was to evaluate the utilization of long-term care service resources by caregivers of patients with dementia (PWD) and to determine affecting factors. In this cross-sectional study, a total of 100 dyads were enrolled and caregivers responded to the questionnaires. We found 40% of caregivers not using any care resources. Between those caregivers using and not-using care resources, we found differences (p < 0.05) in their health status and living conditions; the difference (p < 0.05) was also found in patients’ behavior and psychological symptoms of dementia (BPSD). The frequency of BPSD (OR = 1.045, p = 0.016, 95% CI = 1.001–1.083) and the living conditions (OR = 3.519, p = 0.007, 95% CI = 1.414–8.759) were related to their use of care resources. Particular BPSDs, such as anxiety or restlessness, throwaway food, aggressive behavior, tearing of clothes, and sexual harassment of patients were related to the caregivers’ use of care resources (p < 0.01). Health professionals have to evaluate the patients’ BPSD and identify the caregivers’ essential needs. Individualized medical care and BPSD-related care resources should be provided for patients and caregivers for taking off their care burden and improving patient care.

Effects of low- and high-intensity physical exercise on physical and cognitive function in older persons with dementia: a randomized controlled trial

BackgroundPotential moderators such as exercise intensity or apolipoprotein-E4 (ApoE4) carriership may determine the magnitude of exercise effects on physical and cognitive functions in patients with dementia (PwD). We determined the effects of a 24-week aerobic and strength training program with a low- and high-intensity phase on physical and cognitive function.MethodsIn an assessor-blinded randomized trial, 91 PwD (all-cause dementia, recruited from daycare and residential care facilities, age 82.3 ± 7.0 years, 59 women, Mini-Mental State Examination 20.2 ± 4.4) were allocated to the exercise or control group. In the exercise group, PwD participated in a walking and lower limb strength training program with 12 weeks low- and 12 weeks high-intensity training offered three times/week. Attention-matched control participants performed flexibility exercises and recreational activities. We assessed adherence, compliance, and exercise intensity for each session. We assessed physical (endurance, gait speed, mobility, balance, leg strength) and cognitive (verbal memory, visual memory, executive function, inhibitory control, psychomotor speed) functions with performance-based tests at baseline and after 6, 12, 18, 24, and 36 weeks (follow-up). ApoE4 carriership was determined post-intervention.ResultsSixty-nine PwD were analyzed. Their mean attendance was ~ 60% during the study period. There were no significant effects of the exercise vs. control intervention on endurance, mobility, balance, and leg strength in favor of the exercise group (Cohen’s d = 0.13–0.18). Gait speed significantly improved with ~ 0.05 m/s after the high-intensity phase for exercise participants (Cohen’s d = 0.41) but declined at follow-up. There were no significant effects of the exercise vs. control intervention on any of the cognitive measures (Cohen’s d ~ − 0.04). ApoE4 carriership did not significantly moderate exercise effects on physical or cognitive function.ConclusionsExercise was superior to control activities for gait speed in our sample of PwD. However, the training effect provided no protection for mobility loss after detraining (follow-up). There were no beneficial effects of the exercise vs. control group on cognitive function. Exercise intensity moderated the effects of exercise on gait speed. ApoE4 carriership moderated the effect of exercise on global cognition only (trend level).Trial registrationNetherlands Trial Register, NTR5035. Registered on 2 March 2015.

Assessment of care in patients with dementia in house calls by general practitioners

HintergrundDemenzpatienten (DP) sind eine besondere Herausforderung für das Gesundheitssystem. Auf sie entfallen 5 % der Gesamtausgaben im Gesundheitswesen. Die krankheitsbedingten Defizite und der damit verbundene Versorgungsbedarf führen dazu, dass viele Patienten nicht mehr in der eigenen Häuslichkeit leben können und auf die Versorgung in Pflegeheimen (PH) angewiesen sind.FragestellungWie wird die gesamtheitliche Betreuung von DP im Hausbesuch (HB) eingeschätzt?Hat die regionale Lage Einfluss auf die Wohnsituation bei DP?Material und MethodenIm Rahmen von SESAM‑5 wurden von 303 sächsischen Hausarztpraxen in einem Zeitraum von einem Jahr 4286 HB mittels Fragebogen dokumentiert und sowohl inhaltliche als auch strukturelle Merkmale erfasst.ErgebnisseDie Prävalenz von Demenz bei HB-Patienten betrug 27,5 %. Von diesen bewohnten 72,6 % ein PH oder betreutes Wohnen. Das medizinische Personal schätzte die gesamtheitliche Betreuung von DP im PH signifikant besser ein als in der eigenen Häuslichkeit. Diese Diskrepanz fiel im Vergleich von ländlichen und städtischen Gebieten noch deutlicher aus, obwohl in städtischen Gebieten signifikant mehr Patienten in PH wohnten (27 % vs. 51 %).DiskussionDie Betreuung dementer HB-Patienten wird vom versorgenden Personal überwiegend als gut eingeschätzt, wobei diese bei DP im PH vergleichsweise besser bewertet wird als in der eigenen Häuslichkeit. Dies kann durch einen hohen Versorgungsbedarf der DP erklärt werden. Der Kontrast zwischen ruralen und städtischen Gebieten ist durch infrastrukturelle, aber auch durch organisatorische Unterschiede in ländlichen Bereichen erklärbar, wo signifikant häufiger eine Mitbetreuung durch Angehörige erfolgt. Da bei DP kognitive Defizite im Vordergrund stehen, könnten alternative Wohnformen zukünftig mehr in den Fokus rücken.

The Effect of a Nurse-Led Cognitive Behavioral Protocol on Depressive Symptoms and Coping Strategies of Dementia Caregivers.

Family caregivers of patients with dementia (PWD) often experience depressive symptoms and use poor coping strategies. Cognitive behavioral interventions may enhance positive appraisals of caregiving-related issues and the utilization of active coping strategies among caregivers, which may help prevent caregiver depression. However, there is a shortage of primary, community-based mental health services in China, and little research has been conducted on the effect of nurse-led mental health programs in this population. This study explored the effect of a nurse-led cognitive behavioral intervention on depressive symptoms and coping strategies among family caregivers of PWD in China. This randomized controlled trial used data from a sample of 112 caregivers screened from 276 potential participants in a city in southeastern China. The sample was randomly assigned to an intervention group (n = 56) and a control group (n = 56). The intervention group received five monthly in-home, nurse-led cognitive behavioral sessions and telephone consultations after each session. The control group received five monthly, short, general conversations with nurse interventionists at the participants' homes, in the hospital, or via telephone. Depressive symptoms, coping strategies, and the demographics of caregiving dyads were collected at Time 1 (baseline), Time 2 (the end of the 5-month intervention), and Time 3 (2-month follow-up). IBM SPSS Statistics Version 19.0 was used for data analysis. Eighty-two participants (intervention group: n = 47, control group: n = 35) completed the three evaluations. No significant group differences were found in baseline characteristics between the two groups. The general linear model repeated-measures analysis of variance indicated a significant difference in depressive symptoms and active coping between groups over time, with p < .001 for the interaction between depressive symptoms and groups and p < .01 for the interaction between active coping and groups. A similar result did not occur for passive coping. The t tests further supported a significant interventional effect on participants' depressive symptoms and active coping. This nurse-led cognitive behavioral intervention was effective in decreasing depressive symptoms and improving active coping among study participants. The findings suggest the improvement of mental health services and social policies in China to support family caregivers of PWD.

Mediating effect of social support on the relationship between resilience and burden in caregivers of people with dementia

ObjectiveThis study examined different predictive factors of burden in a sample of family caregivers of patients with dementia (PWD). In particular, the influence of social support and resilience on burden was tested, considering potential mediation effects. MethodsA total of 283 primary and family caregivers in Spain were evaluated using a standardized protocol to assess sociodemographic characteristics, clinical state of PWD and specific variables of caregiving and care providers. ResultsThe role of caregiver of PWD was more common in women, reporting significantly higher levels of burden than men. Resilience and social support accounted for most of the variance in burden. Furthermore, social support partially mediated the relationship between resilience and burden in caregivers. ConclusionsCaregivers’ resilience and social support are protective factors against burden in caregivers of PWD. Both factors should be considered for tailored interventions aimed at reducing the health costs of burden in this population.

Claims Data Analysis on the Dispensing of Tricyclic Antidepressants Among Patients With Dementia in Germany.

Objective: A restrictive use of tricyclic antidepressants (TCA) in patients with dementia (PwD) is recommended due to the hazard of anticholinergic side effects. We evaluated the frequency of TCA dispensing in PwD over a period of 1 year and the use of TCA before and after the incident diagnosis of dementia. Methods: This analysis was based on administrative data from a German statutory health insurance for a period of 2 years. Totally, 20,357 patients with an incident diagnosis of dementia in 2014 were included. We evaluated the dispensing of TCA in 2015. Subgroup analyses were conducted to evaluate associations between the incident diagnosis of dementia and modifications in TCA dispensing. Results: In 2015, 1,125 dementia patients (5.5%) were treated with TCA and 31% were medicated with TCA in all four quarters of 2015. Most dispensings were conducted by general practitioners (67.9%). On average, patients received 3.7 ± 2.6 dispensings per year. Amitriptyline (56.3%), doxepin (26.8%), and trimipramine (16.8%) were dispensed most often. Subgroup analyses revealed that the dispensing of TCA remained mainly unchanged following the incident diagnosis. Conclusion: A relevant number of PwD were treated with TCA. To maintain the patients’ safety, an improved implementation of guidelines for the pharmaceutical treatment of PwD in healthcare institutions might be required. Since 68% of the patients suffered from depression, future studies should further evaluate the indications for TCA.

The associations between behavioral-psychological symptoms of dementia (BPSD) and coping strategy, burden of care and personality style among low-income caregivers of patients with dementia

BackgroundThe main aim of this study was to determine the association between Behavioral and Psychological Symptoms of Dementia (BPSD) and caregiver burden, and the mediating role of coping strategy and personality style of caregivers to patients with dementia (PWD).MethodsThis cross-sectional study was conducted among 202 caregivers to PWD in home-based settings. Recruited caregivers were administered questionnaires regarding BPSD which was measured using Neuropsychiatric Inventory-Questionnaire (NPI-Q), caregiver burden using Zarit Burden Interview (ZBI), Brief COPE for coping strategies and Big-Five Inventory which measured personality traits.ResultsMajority of the caregivers were female (71.3%), aged 50 and above (55%), single (46%), married (43.6%), working full time (45%) while the rest work part time (22.3%), unemployed (7.4%) and retiree (25.2%), and majority were parents (58.9%) and spouse (18.3%). The duration of caregiving was less than a year (33.7%) while the rest are more than a year. Results demonstrated that the most frequent types of BPSD exhibited by PWD was irritability, followed by apathy and agitation. All of the types of BPSD showed to be significantly correlated to caregiver burden except for anxiety, elation and appetite. Of personality traits, only conscientiousness was found to mediate the relationship between BPSD and caregiver burden (p < .05). Self-distraction, active coping, planning and acceptance were the coping strategies that demonstrated to have mediation effect on the relationship between BPSD and caregiver burden.ConclusionPresentation of BPSD is correlated to caregiver burden which is partially mediated by coping strategies and personality styles.

Dyadic Wind of Change: New Approaches to Improve Biopsychological Stress Regulation in Patients with Dementia and Their Spousal Caregivers.

Patients with dementia (PWD) and their caregivers experience long-term stress, leading to accelerated disease progression and to stress-related morbidity. Previous research focused on intrapersonal biopsychological stress responses. Quite recently, dyadic interrelations between caregivers and PWD and their effects on stress and caregiver burden have received more attention, giving rise to dyadic intervention studies. However, while it is of importance to consider both the patient and the caregiver from a dyadic point of view, evaluation of these dyadic interventions considering underlying mechanisms is still lacking. We therefore extend the current literature on dyadic processes between PWD and caregivers by transferring the knowledge about underlying stress-modulating dyadic processes in healthy couples to the dementia patient-caregiver constellation. By targeting dyadic stress co-regulation between PWD and caregivers, we expect significant therapeutic effectiveness. The aims of this article are two-fold: 1) We aim to provide a rationale for incremental benefits of considering dyadic processes among caregivers and PWD by means of elucidating underlying mechanisms and 2) we aim to emphasize the need to evaluate these underlying mechanisms by means of objective physiological stress markers in both PWD and caregivers. Knowledge on these underlying mechanisms will ultimately help developing dyadic interventions tailored to the needs of both PWD and their caregivers.

Diagnostic Behavior for Mild Cognitive Impairment in General and Neuropsychiatric Practices in Germany.

Little is known about the diagnostic methods currently used in routine care for patients with mild cognitive impairment (PwMCI). We estimated the frequency of diagnostic procedures in incident PwMCI compared to incident patients with dementia (PwD) in 2016-2017. The study is based on the Disease Analyzer database. After matching by age and sex, 4,700 PwMCI and 4,700 PwD were available. The diagnostic procedures were identified on the basis of the related medical fee schedule items. All diagnostic procedures were used more frequently in PwMCI than in PwD. The drafting of a practice-oriented MCI guideline is an important task for the future.

Exploring the association between optimism and quality of life among informal caregivers of persons with dementia - CORRIGENDUM

ABSTRACTObjective:We aimed to analyze the relationship between optimism and quality of life (QoL) among informal caregivers of patients with dementia (PWD). DESIGN In this cross-sectional study, a hierarchical multiple linear regression analysis was used to determine the association between optimism and caregiver's QoL after controlling the effect of different covariates, including burden. PARTICIPANTS A sample of 130 PWD and their informal caregivers underwent a comprehensive protocol of assessment. MEASUREMENTS Caregivers completed the Battery of Generalized Expectancies of Control Scales, the Zarit Burden Interview, and the World Health Organization Quality of Life-Brief as measure of QoL. Optimism was estimated based on the combination of three expectancies of control, namely, self-efficacy, contingency, and success. RESULTS QoL correlated positively with optimism and negatively with burden. Optimism predicted each dimension of QoL, even after controlling for the effect of sociodemographic, care-recipients' clinical covariates, and burden in all models. CONCLUSION Optimism consistently predicted well-being and QoL in informal caregivers of PWD.