Caregivers may contribute to Alzheimer's symptoms

By Anne Harding

NEW YORK (Reuters Health) - Symptoms like hallucinations, wandering and paranoia in Alzheimer's patients are more likely to occur if their caregivers are younger, less educated, more heavily burdened or more depressed, a new study shows.

While these symptoms, known collectively as neuropsychiatric symptoms, are due to the Alzheimer's disease process, Dr. Kaycee M. Sink told Reuters Health, environmental factors, caregiver behaviors and caregiving styles may exacerbate them.

"These dementia-related behaviors are probably the number one reason that people get put into a nursing home," she added.

Sink, of Wake Forest University School of Medicine in Winston-Salem, North Carolina, and her colleagues surveyed the caregivers of 5,788 community-dwelling Alzheimer's patients in eight US cities, asking them whether the patient had any of twelve different neuropsychiatric symptoms. On average, caregivers reported patients had about 4 or 5 of these symptoms.

Using statistical techniques to adjust for the effects of the patient's own behavior and severity of dementia, the researchers found that certain caregiver characteristics made neuropsychiatric symptoms more likely in patients.

The strongest effects were seen for burden, depression and age. The youngest caregivers reported 1.5 more neuropsychiatric symptoms in the patient, on average, than the oldest, the researchers report in the Journal of the American Geriatrics Society.

Older caregivers are more likely to be the patient's spouse, rather than a son or daughter or a young hired caregiver, meaning they are familiar with his or her pre-Alzheimer's habits and preferences and better able to adjust the patient's environment appropriately, Sink said in an interview.

Also, more educated caregivers may have better coping skills for dealing with stress, and may also understand dementia better than less educated individuals, she added.

For factors like depression and the burden of patient care experienced by caregivers, Sink said, it's difficult to tell which came first -- the patient's neuropsychiatric symptoms or the caregiver's depression. "You can't really sort out chicken from egg. It's probably more like a vicious cycle," she explained.

"Just addressing the patient or just addressing the caregiver isn't probably going to break that cycle," Sink pointed out.

The findings show that efforts to help caregivers won't work if they are "one size fits all," because younger, less educated caregivers may have very different needs for support and information compared to older, more highly educated caregivers, she said.

Caregivers of Alzheimer's patients need to know, she added, that medication can do little for neuropsychiatric symptoms, but that behavioral and environmental approaches can help.

For example, if a patient insists that his or her dead spouse will be coming to lunch, Sink said, it's better to agree than to try to convince the patient that the spouse is dead. "Sometimes caregivers believe that if they just keep telling the patient, somehow the patient will get it, but they're not going to probably get it and then both parties get frustrated."

When the burden of caring becomes overwhelming, "Caregivers need to know that they should ask for help, ask for support," Sink concluded, "and get educated as to what some of the behaviors represent and behavioral or environmental ways to deal with them."

The Alzheimer's Association offers good information and tips for caregivers on its Web site, Sink added, at www.alz.org.

SOURCE: Journal of the American Geriatrics Society, May 2006.