Zarit Caregiver Burden Inventory Research Articles

Impact of ‘web-based mindfulness based stress reduction combined with solution-focused intervention on dementia caregivers’ negative affect

Objective: This study aims to explore the effects of web-based mindfulness-based stress reduction (MBSR) combined with focused solution mode on alleviating negative emotions in dementia caregivers. Methods: Sixty dementia caregivers were randomly assigned to either a control group receiving conventional guidance or an intervention group receiving MBSR combined with focused solution mode in addition to conventional guidance. The intervention lasted for 8 weeks. Changes in depression-anxiety-stress scale 21 (DASS-21) and Zarit caregiver burden inventory (ZBI) scores were compared between the two groups before and after the intervention. Results: After 8 weeks of intervention, caregivers in the intervention group showed significant decreases in depression, anxiety, stress, and total DASS-21 scores as well as total ZBI score (P<0.001), all of which were lower than those of the control group (P<0.001). Conclusion: MBSR combined with focused solution mode can effectively improve negative emotions and reduce burden levels in dementia caregivers, and is worth promoting and applying in clinical settings.

Caregiver burden and its predictors in adult epilepsy patients

ObjectiveThe aim of this study was to evaluate caregiver burden and factors associated with caregiver burden in caregivers of adults with epilepsy. Materials and methodsThis descriptive cross-sectional study was conducted with 107 patients with epilepsy and 107 their primary caregivers. Personal information form including sociodemographic data and Zarit Caregiver Burden Inventory (ZBI), were used for caregivers, and patient information form, Montreal Cognitive Assessment Scale (MoCA), Hospital Anxiety and Depression Scale (HADS), Epilepsy Quality of Life Scale (QoLIE-31) and Stigma Scale were used for patients. ResultsCaregiver burden was found to be related to gender (p = 0.047), marital status (p = 0.008), income (p = 0.003), education level (p = 0.05) age at onset of epilepsy (p = 0.025) and type of therapy (p = 0.005). The scale scores for cognitive functions (p < 0.001), stigma (p < 0.001), anxiety (p = 0.001), depression (p = 0.005), and quality of life (p < 0.001) of the patient showed significant correlations with caregiver burden. In addition, caregiver burden was found to correlate with some caregiver characteristics such as caregivers‘ age (p = 0.041), gender (p < 0.001), education (p < 0.001), income (p = 0.001) and relationship with the patient (p = 0.016). Time spent on caregiving per day was also positively correlated with caregiving burden (p < 0.001). In regression analysis, the gender of the caregiver, the gender of the patient, the stigma level of patient, and the type of treatment were found to be predictors of care burden (p < 0.05, R2 = 0.61). ConclusionIt was found that two-thirds of the families of patients with epilepsy experienced varying degrees of caregiver burden. In addition, it was determined that caregiver burden was associated with sociodemographic and numerous psychosocial factors of the patient as well as the caregiver. It is important that both the caregiver and the patient being cared for are closely evaluated in interventions to reduce the caregiver burden in patients with epilepsy.

Staging Parkinson's disease according to the MNCD classification correlates with caregiver burden.

Recently, we demonstrated that staging Parkinson's disease (PD) with a novel simple classification called MNCD, based on four axes (motor, non-motor, cognition, and dependency) and five stages, correlated with disease severity and patients' quality of life. Here, we analyzed the correlation of MNCD staging with PD caregiver's status. Data from the baseline visit of PD patients and their principal caregiver recruited from 35 centers in Spain from the COPPADIS cohort from January 2016 to November 2017 were used to apply the MNCD total score (from 0 to 12) and MNCD stages (from 1 to 5) in this cross-sectional analysis. Caregivers completed the Zarit Caregiver Burden Inventory (ZCBI), Caregiver Strain Index (CSI), Beck Depression Inventory-II (BDI-II), PQ-10, and EUROHIS-QOL 8-item index (EUROHIS-QOL8). Two hundred and twenty-four PD patients (63±9.6 years old; 61.2% males) and their caregivers (58.5±12.1 years old; 67.9% females) were included. The frequency of MNCD stages was 1, 7.6%; 2, 58.9%; 3, 31.3%; and 4-5, 2.2%. A more advanced MNCD stage was associated with a higher score on the ZCBI (p<.0001) and CSI (p<.0001), and a lower score on the PQ-10 (p=.001), but no significant differences were observed in the BDI-II (p=.310) and EUROHIS-QOL8 (p=.133). Moderate correlations were observed between the MNCD total score and the ZCBI (r=.496; p<.0001), CSI (r=.433; p<.0001), and BDI-II (r=.306; p<.0001) in caregivers. Staging PD according to the MNCD classification is correlated with caregivers' strain and burden.

Effect of support based on family centered empowerment model on care burden in family caregivers of patients with multiple sclerosis.

Family caregivers of patients with multiple sclerosis (MS) are at risk of care burden that may lead to a detrimental effect on their quality of life (QoL), physical and mental well-being. This study aimed to determine the effect of the family-centered empowerment model (FCEM) on the care burden of caregivers of patients with MS. This quasi-experimental study was conducted using convenience sampling on 60 caregivers of patients referring to the Multiple Sclerosis Clinic in Ghaem Hospital, Mashhad, Iran. The participants were assigned to FCEM and control groups based on the days they were referred to the MS clinic. Data collection tools included the Zarit Caregiver Burden Inventory (CBI), completed in the intervention and control groups before and 1 month after the intervention. The support based on FCEM was provided during eight 45-60-min sessions, and the control group received the medical center's routine training. Data were analyzed by Chi-square, independent t-test, analysis of covariance, and repeated measure tests. The results of the present study showed that all demographic characteristics were homogeneous at the baseline. Before the intervention, no significant difference was observed between the two groups regarding mean scores of care burden. Based on the repeated measure test, there was no significant treatment and time interaction in changes in care burden. The FCEM has no significant effect in alleviating the care burden. It is recommended to observe the necessary considerations regarding the context of this type of intervention and to carry out further investigations in different intervals.

Effectiveness of motor-cognitive dual-task exercise via telerehabilitation in Alzheimer’s disease: An online pilot randomized controlled study

ObjectiveIt is important to investigate the effectiveness of delivering the rehabilitation service using remote communication technologies, for conditions that face-to-face treatment is not possible. This study aimed to investigate the effectiveness of exercise treatment via home-based telerehabilitation (TR) in Alzheimer’s disease (AD). MethodsTwenty participants who were diagnosed as having the early-middle stage of AD were randomized into a TR group and control group. The TR group received real-time motor-cognitive dual-task exercise treatment via video conferencing, and the control group received no intervention for 6 weeks. The primary outcomes were Mini-Mental State Examination, Timed Up&Go Test, and the 5 Times Sit&Stand Test, and the secondary outcomes were One-leg Stance Test (OLST), Katz Activities of Daily Living Scale (Katz-ADL), Functional Independence Measure, Geriatric Depression Scale-Short Form, Beck Anxiety Scale, Zarit Caregiver Burden Inventory (ZCBI) and the Warwick Edinburgh Well-being Scale. Outcomes were measured at baseline and post-treatment. ResultsThere was a significant difference in the mean change between the groups in favor of the TR group in all primary and secondary outcomes (p < .05), except for the ZCBI and OLST(p > .05). There was no significant difference in the comparison of the primary outcome measures between the groups in post-treatment results (p > .05); significant differences in all secondary outcome measures were observed in favor of the TR group (p < .05), except for the OLST, Katz-ADL, and ZCBI (p > .05). ConclusionTR may provide a significant change in cognition and mobility, improve functional independence, and caregiver’s well-being, and reduce anxiety and depressive symptoms in people with AD.

Predictors of the change in burden, strain, mood, and quality of life among caregivers of Parkinson's disease patients.

Caregiver burden in Parkinson's disease (PD) has been studied in many cross-sectional studies but poorly in longitudinal ones. The aim of the present study was to analyze the change in burden, strain, mood, and quality of life (QoL) after a 2-year follow-up in a cohort of caregivers of patients with PD and also to identify predictors of these changes. PD patients and their caregivers who were recruited from January/2016 to November/2017 from 35 centers of Spain from the COPPADIS cohort were included in the study. They were evaluated again at 2-year follow-up. Caregivers completed the Zarit Caregiver Burden Inventory (ZCBI), Caregiver Strain Index (CSI), Beck Depression Inventory-II (BDI-II), and EUROHIS-QOL 8-item index (EUROHIS-QOL8) at baseline (V0) and at 2-year follow-up (V2). General linear model repeated measure and lineal regression models were applied. Significant changes, indicating an impairment, were detected on the total score of the ZCBI (p<0.0001), CSI (p<0.0001), BDI-II (p=0.024), and EUROHIS-QOL8 (p=0.002) in 192 PD caregivers (58.82±11.71years old; 69.3% were females). Mood impairment (BDI-II; β=0.652; p<0.0001) in patients from V0 to V2 was the strongest factor associated with caregiver's mood impairment after the 2-year follow-up. Caregiver's mood impairment was the strongest factor associated with an increase from V0 to V2 on the total score of the ZCBI (β=0.416; p<0.0001), CSI (β=0.277; p=0.001), and EUROHIS-QOL (β=0.397; p=0.002). Burden, strain, mood, and QoL were impaired in caregivers of PD patients after a 2-year follow-up. Mood changes in both the patient and the caregiver are key aspects related to caregiver burden increase.

Factors associated with caregiver burden of adults with epilepsy in a middle-income country

PurposeDespite the relevance of socio-economic background in burden of caregivers of persons with epilepsy (PWE), there is a dearth of knowledge about this topic in low-resource settings. Here we attempt to identify the extent of the burden in caregivers of adults with epilepsy in a middle-income country and the factors associated with it. MethodsIn this cross-sectional study, we evaluated the level of burden with the Zarit Caregiver Burden Inventory. A comprehensive questionnaire was developed to assess the demographics of patients and caregivers. Epilepsy-related factors were obtained by interview and file review. Depressive, anxiety symptoms, and sleep quality were evaluated by Beck Depression Inventory, State and Trait Anxiety Inventory, and Pittsburgh Sleep Quality Index. Stigma was evaluated by the Stigma Scale of Epilepsy. ResultsThe caregiver's burden was mild to moderate in our sample. The factors most strongly associated with the higher caregiver burden were age-onset of epilepsy, PWE years of schooling, needs for assistance in daily life, disabilities, and caregiver's bad-quality of sleep and higher depressive and anxiety symptoms. ConclusionCaregivers of PWE deserve special attention regarding mental health and other health aspects, such as sleep quality.

Caregiver burden in psychogenic non-epileptic seizures

ObjectiveCaregiver burden in psychogenic non-epileptic seizures (PNES) is an important but understudied reality. The objective of this exploratory study was to quantify caregiver burden in PNES and to identify the patient and caregiver characteristics associated with it. MethodsPNES patients and their identified caregivers completed surveys about demographic, disease related and psychosocial characteristics during their Epilepsy Monitoring Unit (EMU) admission. Associations were evaluated using the Zarit Caregiver Burden Inventory (ZCBI) score as an independent variable and the patient and caregiver related characteristics as dependent variables. Results43 patients and 28 caregivers were recruited. The patients were on average 36 years old, single women, unemployed, with some college education. They suffered from PNES on average for 8 years, having approximately 20 seizures per month, and were previously maintained on ≥ 2 antiseizure medications. Most caregivers were first degree relatives with a mean age of 43 years, married employed women of higher educational attainment, typically cohabitating with the patients. Caregiver burden was within the mild-moderate range (ZCBI mean score 28). The burden appeared higher in caregivers of male patients. Patient quality of life, depression and medication side effects were associated with that burden. Additionally, caregiver stigma, depression and anxiety emerged as potential contributors. In the multivariate analysis, patient quality of life and caregiver depression stood out as the most robust factors. ConclusionThere is substantial caregiver burden in PNES. It is associated with both the patient and the caregiver psychosocial well-being in a reciprocal relationship.

5-2-1 Criteria: A Simple Screening Tool for Identifying Advanced PD Patients Who Need an Optimization of Parkinson's Treatment.

Objective 5- (5 times oral levodopa tablet taken/day) 2- (2 hours of OFF time/day) 1- (1 hour/day of troublesome dyskinesia) criteria have been proposed by a Delphi expert consensus panel for diagnosing advanced Parkinson's disease (PD). The aim of the present study is to compare quality of life (QoL) in PD patients with “5-2-1 positive criteria” vs QoL in PD patients without “5-2-1 positive criteria” (defined as meeting ≥1 of the criteria). Methods This is a cross-sectional, observational, monocenter study. Three different instruments were used to assess QoL: the 39-Item Parkinson's Disease Quality of Life Questionnaire Summary Index Score (PDQ-39SI); a subjective rating of perceived QoL (PQ-10); and the EUROHIS-QOL 8-Item Index (EUROHIS-QOL8). Results From a cohort of 102 PD patients (65.4 ± 8.2 years old, 53.9% males; disease duration 4.7 ± 4.5 years), 20 (19.6%) presented positive 5-2-1 criteria: 6.9% for 5, 17.6% for 2, and 4.9% for 1. 37.5% (12/32) and 25% (5/20) of patients with motor complications and dyskinesia, respectively, presented 5-2-1 negative criteria. Both health-related (PDQ-39SI, 25.6 ± 14 vs 12.1 ± 9.2; p < 0.0001) and global QoL (PQ-10, 6.1 ± 2 vs 7.1 ± 1.3; p=0.007; EUROHIS-QOL8, 3.5 ± 0.5 vs 3.7 ± 0.4; p=0.034) were worse in patients with 5-2-1 positive criteria. Moreover, nonmotor symptoms burden (Non-Motor Symptoms Scale total score, 64.8 ± 44.8 vs 39.4 ± 35.1; p < 0.0001) and autonomy for activities of daily living (ADLS scale, 73.5 ± 13.1 vs 89.2 ± 9.3; p < 0.0001) were worse in patients with 5-2-1 positive criteria. Patient's principal caregiver's strain (Caregiver Stain Index, 4.3 ± 3 vs 1.5 ± 1.6; p < 0.0001), burden (Zarit Caregiver Burden Inventory, 28.4 ± 12.5 vs 10.9 ± 9.8; p < 0.0001), and mood (Beck Depression Inventory II, 12.2 ± 7.2 vs 6.2 ± 6.1; p < 0.0001) were worse in patients with 5-2-1 positive criteria as well. Conclusions QoL is worse in patients meeting ≥1 of the 5-2-1 criteria. This group of patients and their caregivers are more affected as a whole. These criteria could be useful for identifying patients in which it is necessary to optimize Parkinson's treatment.

Neuropsychiatric Symptoms and Caregiver Burden in Parkinson's Disease.

Objective:Parkinson’s disease (PD) is a neurodegenerative disorder. It has a significant impact on the quality of life of patients and their caregivers. The present study aims to study the phenomena of neuropsychiatric symptoms and their association with caregiver burden in PD.Methods:The study was conducted in 100 patients of Parkinson’s disease and their primary caregivers. The patients of PD were diagnosed on the basis of UK Brain Bank criteria; severity/staging of Parkinson’s disease was done by Movement Disorder Society - Unified Parkinson’s disease rating scale (MDS-UPDRS-III). Patients who fulfilled inclusion and exclusion criteria were recruited for the study. The neuropsychiatric evaluation was based on Neuropsychiatric Inventory-Questionnaire (NPI-Q). Caregiver burden was assessed with the Zarit Caregiver Burden Inventory (ZCBI).Results:Mean age of PD patients was 61.48 ± 6.71 years, majority of them were males (68%). Mean total NPI score of patients was 44.46 ± 5.38. Mean age of caregivers was 52.26 ± 6.80 years, majority of them were females (72%) and spouse (76%) in relation to the patient. Caregiver burden was significantly related to age of the patient, duration of illness, severity of illness, and total NPI score.Conclusion:Neuropsychiatric symptoms significantly contribute to the caregiver burden in Parkinson’s disease.

Individual therapeutic-cognitive intervention of the psychological and behavioural symptoms of patients with dementia (PRESTA study)

IntroductionThe behavioral and psychological symptoms of dementia (BPSD) frequently appear associated with patients with dementia, aggravating their cognitive and behavioral status, which generates anguish for their main caregivers. Non-pharmacological therapies are a method to approach BPSD. AimTo analyze the effectiveness of a behavioral educational intervention and support to the family caregiver on the reduction of its overload, and if this reduction has a positive impact on BPSD of the patient with dementia. MethodsA randomized, controlled, double-blind trial was conducted with patients with dementia and their principal caregivers (PC). The PC were randomized to the intervention group (IG) or control (CG). The intervention consisted an individual cognitive-behavioral education performed by outpatient nursing, with periodic telephone contacts, during 3 months. CG received treatment as usual. Cognitive function was assessed using the cognitive scale Mini-Mental State Exploration (MMSE), Neuropsychiatric inventory (NPI-10) and depressive Geriatric Depression Scale (GDS). And caregiver reported burden through (Zarit Caregiver Burden Inventory). The Quantitative and qualitative data of SPCD’s were collected at baseline and after the intervention. ResultsThe mean total age of patients was 78.96 (± 6.64) years and 50% were men. And in PC (n = 28) of 58.64 (± 11.69) years, and 92.9% were women. The IG (n = 13) showed better score than the CG (n = 15) in the MMSE p < 0,001 and the GDS p < 0,001, although without changes in the NPI-10 (p = 0,419), between the start visit and at 3 months, indicating improvement cognitive and depressive after the intervention. The PC also obtained statistically significant scores in the Zarit (p = 0,010). SPCD’s improved significantly in GI: repetition p < 0,001, depression (p = 0,013), apathy and indifference (p = 0,003), sleep and diurnal rhythm disorders (p = 0,006) and eating disorders (p = 0,019) at 3 months. Clinicaltrials.gov Identifier: NCT03732521. ConclusionsThe non-pharmacological therapy of individual therapeutic-cognitive intervention directed to caregivers and carried out by nursing personnel expert in its management, has a favorable impact in the control and reduction of the SPCD of patients with dementia.

Intervención terapéutico-cognitiva individual de los síntomas psicológicos y conductuales de pacientes con demencia (estudio PRESTA)

IntroductionThe behavioural and psychological symptoms of dementia (BPSD) are frequently associated with patients with dementia, aggravating their cognitive and behavioural status, which generates anguish for their main caregivers. Non-pharmacological therapies are a method to approach BPSD. AimTo analyse the effectiveness of a behavioural educational intervention and support to the family caregiver in reducing overload, and whether this reduction has a positive impact on the BPSD of the patient with dementia. MethodA randomised, controlled, double-blind trial was conducted with patients with dementia and their principal caregivers (PC). The PC were randomised to either the intervention (IG) or control group (CG). The intervention comprised an individual cognitive-behavioural education intervention performed by outpatient nursing, with periodic telephone contacts, over 3 months. The CG received treatment as usual. Cognitive function was assessed using the cognitive scale Mini-Mental State Exploration (MMSE), Neuropsychiatric inventory (NPI-10) and depressive Geriatric Depression Scale (GDS). And caregiver-reported burden using the Zarit Caregiver Burden Inventory. The qualitative and qualitative data of the BPSD were collected at baseline and after the intervention. ResultsThe mean total age of the patients was 78.96 (± 6.64) years, and 50% were men. And in the PC (n=28) it was 58.64 (± 11.69) years, and 92.9% were women. The IG (n=13) showed a better score than the CG (n=15) in the MMSE P<.001 and the GDS P<.001, although without changes in the NPI-10 (P=0,419), between the start visit and at 3 months, indicating improvement in cognitive and depressive symptoms after the intervention. The PC also obtained statistically significant scores on the Zarit scale (P=.010). BPSD improved significantly in the IG: repetition P<.001, depression (P =.013), apathy and indifference (P=.003), sleep and diurnal rhythm disorders (P=.006), and eating disorders (P=.019) at 3 months. Clinicaltrials.gov Identifier: NCT03732521. ConclusionsNon-pharmacological therapy of individual therapeutic-cognitive intervention targeted at caregivers and carried out by nursing personnel expert in its management, has a favourable impact on the control and reduction of the BPSD of patients with dementia.

C-38 Telehealth Dementia Management in a Memory Care Unit: Survey Response Rates and Quality of Life

Abstract This feasibility study assessed changes in patient, staff, and family member ratings over time in a program using technology in patient care on an inpatient dementia unit in a nursing home. Method Dementia patients [N = 17; 50% Female; Age M (SD) = 84.56 (7.12); CDR M (SD) = 2.24 (5.17); MoCA M (SD) = 6.67 (.75)], caregivers (N = 17), and staff (N = 27) at a locked memory unit of a long-term care facility in the southern U.S. consented and enrolled in an individualized care program that implemented telehealth visits between a neuropsychologist and residents with staff. The start and end dates of the group varied due to new admissions and deaths. A feasibility study using a repeated measures design was conducted with monthly data collected from questionnaires (Quality of Life (QoL), Professional Care Team Burden (PCTB) Scale, and Zarit Caregiver Burden Inventory). Results QoL in residents as rated by staff was stable over a five-month interval [Baseline M (SD) = 37.94 (7.28); Month-5 M (SD) = 37.13(5.96), p = 0.98]. PCTB and Zarit responses were adequate at baseline (96.3% and 94.4%); however, due to poor response rates at Month 5 (14.3% and 27.2%), comparisons weren’t possible. Conclusion Changes in patient quality of life were not found over a five-month period. However, due to the severity and progression of dementia, a neutral finding may be positive. Anecdotally, perceptions of the program were positive. However, due to low survey response rates, we cannot accurately translate the benefits to the staff and family. Future studies should assess improving response rate or alternate forms of data collection. Generalizability is limited by size and setting.

Anosognosia Is Associated With Greater Caregiver Burden and Poorer Executive Function in Huntington Disease.

Anosognosia, or unawareness of one's deficits, is estimated to occur in 25% to 50% of Huntington disease (HD). The relationship between anosognosia and increased caregiver burden found in other dementias has not been determined in HD. Patient-caregiver dyads presenting to a statewide HD clinic were assessed using the Anosognosia Scale and grouped into "anosognosia" and "no anosognosia." Caregiver burden, measured by Zarit Burden Interview (ZBI) and Caregiver Burden Inventory (CBI), demographic data, and Unified Huntington's Disease Rating Scale, including Mini-Mental State Examination, Stroop, Trail Making, Verbal Fluency, and Symbol Digit Modalities Tests, were compared between groups. Of the 38 patients recruited, 10 (26.3%) met criteria for anosognosia. Patients with anosognosia elicited higher caregiver burden ratings on both the ZBI (mean difference 16.4 [12.1], P < .001) and CBI (16.7 [15.0], P < .005) while also demonstrating poorer executive function. Except for CAG burden score, between-group characteristics did not differ significantly. Stroop Interference predicted both anosognosia and caregiver burden. In HD, anosognosia is associated with greater caregiver burden and executive deficits. Its occurrence should prompt further patient assessment and increased caregiver support.

Caregiver Burden and Quality of Life in Early and Late Stages of Idiopathic Parkinson's Disease.

ObjectiveIdiopathic Parkinson’s disease (IPD) is a chronic progressive neurodegenerative movement disorder characterized by motor and non-motor symptoms that affects patients’ quality of life and caregiver burden. The aim of our study was to assess the caregiver burden (CB) in early and late stages of disease and to search if there was a relationship between quality of life and CB. MethodsA total of 74 patients who were diagnosed as having IPD by a movement disorder neurologist according to United Kingdom Brain Bank Criteria and their caregivers were randomly selected for participation the study. Staging of PD was performed by the neurologist based on the Hoehn and Yahr (H&Y) Scale. Disease severity was determined using the Unified Parkinson’s Disease Rating Scale (UPDRS). CB was evaluated using the Zarit Caregiver Burden Inventory (ZCBI). The Hospital Anxiety and Depression Scale (HADS) and the Beck Depression Inventory (BDI) were used to assess anxiety and depressive symptoms in patients with IPD and their caregivers. The Short-Form Health Survey instrument (SF-36) was used to evaluate quality of life of the patients. The Mini-Mental State Examination (MMSE) was administered to patients to evaluate gross cognitive status. ResultsSeventy-four patients (male, 58.1%) were included in the study. The mean age of patients was 66.18±8.5 and the mean duration of disease was 67.23±41.8 months. According to the H&Y scale, the patients were divided into two groups; stage I–II as early stage and stage III–V as late stage. Group 1 (H&Y I–II) consisted of 40 patients, and group 2 (H&Y III–V) comprised 34 patients. The mean duration of disease and UPDRS scores were significantly higher in group 2 (p=0.003, p=0.001, respectively). Significant differences were found in group 2 according to BDI. There were significant differences between group 1 and 2 according to SF-36 subdomains such as general health, emotional role, social functioning, pain, and mental health (p=0.019, p=0.038, p=0.005, p=0.004, p=0.014, respectively). However, there were no significant differences between these two groups concerning CB. ConclusionAlthough CB was found in 35 (47.3%) caregivers in our study, we found no significant differences between the caregivers of patients with early and late-stage IPD patients. We thought that this might be due to strong family relationships and cultural dynamics in Turkey. Burden was found to be higher in depressive patients’ CGs and CGs who had depressive symptoms. It is important to recognize depressive symptoms earlier to protect the relationship between the CG and the patient because the main providers of care are family members.

Predictors of depression and anxiety among caregivers of hospitalised advanced cancer patients.

Cancer is a chronic disease that requires long-term treatment and care. Caregivers of cancer patients are at greater risk of developing depression than the general population. The effect of caregivers' cognitive flexibility on depression and anxiety has not been well studied. We aimed to investigate the social characteristics, burden levels and cognitive flexibility of caregivers of advanced cancer patients, and determine the relationship between these factors and depression and anxiety. We hypothesised that factors such as cognitive flexibility and caregiver burden level significantly predict anxiety and depression. The study included 69 primary informal caregivers of patients with Stage 4 cancer. Methods utilised included diagnostic semi-structured interviews, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Zarit Caregiver Burden Inventory and cognitive flexibility inventory. BDI scores were found to be significantly higher in caregivers who cared for men compared to those who cared for women (20.44 ± 2.06 vs. 13.29 ± 1.81; t = 2.60; p = 0.01). BDI mean scores were statistically lower in caregivers who received help with caregiving compared to those who did not (t = 2.62; p = 0.01). Cognitive flexibility level, burden level and lack of social support were found to be predictors of caregiver depression. The study showed that individuals with low cognitive flexibility levels are more likely to have depressive and anxiety symptoms. Based on our findings, we opine that evaluations of caregivers' cognitive strategies and social support are needed to determine the risk of depression in caregivers of cancer patients.

Effect on community-based adapted tango for patients with Parkinson's disease and their caregivers

People with Parkinson's disease (PD) frequently have low activity levels, reduced quality of life and their caregivers often experience social isolation. Recent evidence suggests that tango dance program improve balance, functional mobility, spatial cognition and quality of life for patients. The aim of this study was to evaluate the impact on caregivers’ burden feelings. People with Parkinson disease and their caregivers participated in an adapted tango for PD dancing classes once per week for 3 months in Montpellier in France. Both balance (Berg Balance Scale, sit to stand test), gait (6-Minute Walk Test T6 M), mood (Hospital Anxiety and Depression Scale) and caregivers burden (Zarit Caregiver Burden Inventory) were assessed prior and after therapy with appropriate tools and questionnaires. We analyzed pre-/post-differences with Wilcoxon tests. Twenty-eight patients (not only Parkinson disease but also atypical forms, Hoehn and Yahr: 2.5 ± 0.65, duration of the disease: 7.4 y ± 5.1) and 18 caregivers enrolled in the program. Participants significantly improved at the Berg Balance Scale (54.3 ± 3.55 vs. 52.61 ± 5.03, P = 0.03). No significant improvement was observed on the other tests: sit to stand, T6 M, Hospital and Anxiety depression scale. We even noted an increasing Zarit scale (32.7 ± 17.9 vs. 25.5 ± 18.3) for the caregivers. Eight of them experienced infectious disease, cancer or stroke during the program, in accordance with their fragility. As previously demonstrated, adapted tango was effective in improving balance in PD patients. In our study, we noted that even if, tango partenered dance is not enough to relieve caregivers from the stress of providing continuous care, we observe that, from now on, most of caregivers are able to recognize the signs of caregiver stress, so they can seek the necessary support.

Analysis of caregiver burden of relative caregivers of multiple myeloma patients and its influencing factors

Objective To investigate the current situation of caregiver burden of relative caregivers of multiple myeloma patients, and to analyze its influencing factors. Methods Cross-section investigation method was used in the study. A total of 125 multiple myeloma patients and their relative caregivers, who accepted treatment in the hematology department of He'nan Provincial People's Hospital from December 2015 to March 2017 were selected by convenience sampling method. The general situation investigation questionnaire, Zarit Caregiver Burden Inventory (ZBI) , Barthel Index (BI) , Social Support Rating Scale (SSRS) and Connor-Davidson Resilience Scale (CD-RISC) were adopted in the investigation. PASW 18.0 software was adopted for statistical analysis of the data. Results The ZBI score of the relative caregivers of multiple myeloma patients was (57.01±15.36) , and 86.4% of the caregivers' scored at a moderate level and over. The differences of ZBI scores of the caregivers with different educational background, family average monthly income, caring time and the different numbers of complications in patients were statistically significant (t/F/H=3.924, 9.656, 8.062, 20.608; P<0.05) . The average score of BI in multiple myeloma patients was (53.56±8.30) , with moderate dysfunction, which was negatively correlated with the total score of ZBI and the scores of its all dimensions (P<0.01) . The average score of SSRS in the caregivers was (48.18±8.53) , with a high level of social support, and the average score of CD-RISC was (64.50±9.41) , the two of which were both negatively correlated with the total score of ZBI and the scores of its all dimensions (P<0.05) . As indicated by the results of multiple linear regression analysis, the complication number and self-care ability of the patients as well as the average monthly family income, caregiving time, social support and mental elasticity of the relative caregivers could be included in the regression equation, which explained 40.1% of the variance. Conclusions The caregiver burden of patients with multiple myeloma is relatively heavy. The complication number and self-care ability of the patients as well as the average monthly family income, caregiving time, social support and mental elasticity of the relative caregivers are the influencing factors of caregiver burden. Key words: Cross-sectional studies; Multiple myeloma; Caregivers; Caregiver burden; Influencing factors

Caregiver burden and quality of life in early stages of idiopathic Parkinson's disease.

The aim of this study was to assess the impact of early stage of idiopathic Parkinson's disease (IPD) on caregiver burden with disease severity, duration, disability and psychiatric symptoms. 30 IPD patient (15 female, 15 male) - caregiver (18 female, 12 male) pairs participated in the study. Hoehn and Yahr (H-Y) scale was used to provide the assessment of disease progression and Unified Parkinson's Disease Rating Scale (UPDRS) was used for assessing disability and impairment. Zarit Caregiver Burden Inventory (ZCBI) was used to ascertain the distress experienced by caregivers. Hospital Anxiety and Depression scale (HADS) was performed on both patient and caregiver groups to evaluate anxiety and depression. Depressive symptoms of both groups were also measured by Beck Depression Inventory (BDI). Patients' psychotic symptoms were assessed using the part 1- mentation, behavior and mood section of UPDRS. Mini-Mental State Examination (MMSE) was used to evaluate dementia symptoms and Short Form-36 (SF-36) was also used to assess quality of life. We found significant correlation between caregiver burden with disease severity and duration. There was a significant difference between high UPDRS scores and the caregiver's will for placing her/his patient in a long-term institution. Patients who had depression risk according to BDI had also high UPDRS scores. Patients with off period had higher UPDRS scores and lower SF-36 subdomains of general health, physical functioning, emotional role and social functioning. IPD is a chronic, progressive neuro- degenerative disease and comprises substantial burden on patients, families of patients and caregivers. The disease duration and disability have a remarkable impact on caregiver burden. For the good quality of caregiving, protective therapies should be recommended for caregivers if needed.

High Burden and Depression Among Late-Stage Idiopathic Parkinson Disease and Progressive Supranuclear Palsy Caregivers.

Caregivers of patients with late-stage idiopathic Parkinson disease (IPD) and late-stage progressive supranuclear palsy (PSP) often suffer from severe psychological strain themselves. This study investigates the influence of the different kind of symptoms in IPD and PSP on the psychological burden of the caregivers. Twenty patients with late-stage IPD and 20 patients with late-stage PSP and their caregivers were investigated. To measure the degree of motor, cognitive, and affective impairment of the patients, the instruments Subscale III of the Unified Rating Scale for Parkinsonism (UPDRS-III), a shortened 24-item version of the Mini-Mental State Examination, and the Geriatric Depression Scale (GDS-30) were used. Psychological burden of the caregivers was determined by using the Beck Depression Inventory (BDI-II) and the Zarit Caregiver Burden Inventory (ZBI). Patients with IPD suffered from a higher level of depression (GDS-30: 15.9 vs 10.2, P = .020), whereas patients with PSP showed greater motor impairment (UPDRS-III: 38.3 vs 29.9, P = .002). Caregivers of both groups reported high psychological burden (ZBI: 36.5 in IPD vs 42.8 in PSP) and symptoms of a depression (BDI-II: 12.5 in IPD vs 15.1 in PSP). No significant influence of motor impairment, cognitive dysfunction, and depressive symptoms of the patient on the burden of the caregiver could be found. Psychological strain and depression among caregivers seem to become even more relevant in the late stages of IPD and PSP. Further studies will be necessary to investigate the specific determining factors in late-stage parkinsonian syndromes.