The differential impact of unique behavioral and psychological symptoms for the dementia caregiver: How and why do patients' individual symptom clusters impact caregiver depressive symptoms?

Objective: The behavioral and psychological symptoms associated with dementia (BPSD) are highly burdensome to caregivers. While BPSD consist of a wide variety of patient behaviors including depression, physical aggression, and paranoid delusions, it remains unclearwhether specific symptoms have a differential impact on caregivers. The aims of this study were 1) to assess howindividual BPSD, categorized based on howthey may affect caregivers, impact depressive symptoms for dementia patient caregivers and 2) to test the pathways by which BPSD clusters impact caregiver depressive symptoms. Design: Cross-sectional analysis of data from a longitudinal study of patients with Alzheimer disease and dementia with Lewy bodies. Setting: Multiple U.S. dementia clinics. Participants: One hundred sixty patientecaregiver dyads. Methods: Using multivariate generalized estimating equation logistic models, we analyzed the relationship between four BPSD clusters (patient depressive symptoms, accusatory/aggressive behaviors, nonthreatening psychotic symptoms, and difficult to manage behaviors) and caregiver depressive symptoms and assessed mediators of these relationships. Results: Only the presence of patient depressive symptoms was associated with caregiver depression (odds ratio: 1.55;95% confidence interval: 1.14-2.1). This relationship was mediated by caregiver report of both the symptom's impact on the patient and perceived burden to caregivers. Conclusion: Patient depressive symptoms may be the most important driver of the relationship between BPSD and caregiver depression. Research in this field should further test the effects of individual BPSD and also consider how symptoms may negatively impact caregivers by increasing burden and evoking empathy for the patient.