ABSTRACT
INTRODUCTION: The care of patients with Alzheimer's disease increases the burden and depression of the main caregiver, although the relationship between the two is not clearly defined. AIMS: To explore the factors associated with depressive symptomatology and burden in the main caregiver and to apply a model of structural equations to identify the relationship between them. SUBJECTS AND METHODS: The sample consisted of 127 family caregivers of people with Alzheimer's disease, with a follow-up of 24 months. Multivariate regression analyses were performed to identify the characteristics of patients and caregivers associated with burden and depression of the main caregiver, and a model of structural equations was designed to analyse the relationship between the variables. RESULTS: In the model of structural equations, the burden had a direct effect on depression, both in the baseline assessment and at 24 months. The variables associated with burden were: schooling and the lower mental health of the main caregiver; and the behavioral alterations and the functional dependency of the patient. The lower cognitive level of the patient and the lower mental health of the main caregiver were associated with depression. The correlation between burden and depression increased from baseline to two years (r = 0.470 vs. r = 0.613). CONCLUSIONS: The deterioration of the patient and caregiver burden are risk factors for depression in the main caregiver. Interventions would be necessary to reduce the burden and prevent related depression.
TITLE: Sintomas depresivos y sobrecarga en los familiares cuidadores en la enfermedad de Alzheimer: un modelo de ecuaciones estructurales.Introduccion. El cuidado de los pacientes con enfermedad de Alzheimer incrementa la sobrecarga y la depresion del cuidador principal, aunque la relacion entre ambas no esta claramente definida. Objetivos. Explorar los factores asociados a la sintomatologia depresiva y la sobrecarga en el cuidador principal y aplicar un modelo de ecuaciones estructurales para identificar la relacion entre ellas. Sujetos y metodos. La muestra estuvo formada por 127 cuidadores familiares de personas con enfermedad de Alzheimer, con un seguimiento de 24 meses. Se realizaron analisis de regresion multivariante para identificar las caracteristicas de pacientes y cuidadores asociadas a la sobrecarga y la depresion del cuidador principal, y se diseño un modelo de ecuaciones estructurales para analizar la relacion entre las variables. Resultados. En el modelo de ecuaciones estructurales, la sobrecarga tuvo un efecto directo sobre la depresion, tanto en la evaluacion basal como a los 24 meses. Las variables asociadas a la sobrecarga fueron: la escolaridad y la menor salud mental del cuidador principal, y las alteraciones conductuales y la dependencia funcional del paciente. El menor nivel cognitivo del paciente y la menor salud mental del cuidador principal estuvieron asociados a la depresion. La correlacion entre sobrecarga y depresion aumento desde la evaluacion basal hasta los dos años (r = 0,47 frente a r = 0,613). Conclusiones. El deterioro del paciente y la sobrecarga son factores de riesgo para la depresion en el cuidador principal. Serian necesarias intervenciones para reducir la carga y poder prevenir la depresion relacionada.
Subject(s)
Alzheimer Disease , Caregivers/psychology , Cost of Illness , Depression/epidemiology , Models, Theoretical , Aged , Aged, 80 and over , Alzheimer Disease/therapy , Female , Humans , Longitudinal Studies , MaleABSTRACT
INTRODUCTION: Brief cognitive tests (BCT) may help detect cognitive impairment (CI) in the clinical setting. Several BCT have been developed and/or validated in our country, but we lack specific recommendations for use. DEVELOPMENT: Review of studies on the diagnostic accuracy of BCT for CI, using studies conducted in Spain with BCT which take less than 20 min. We provide recommendations of use based on expert consensus and established on the basis of BCT characteristics and study results. CONCLUSION: The Fototest, the Memory Impairment Screen (MIS) and the Mini-Mental State Examination (MMSE) are the preferred options in primary care; other BCT (Clock Drawing Test [CDT], test of verbal fluency [TVF]) may also be administered in cases of negative results with persistent suspected CI or concern (stepwise approach). In the specialised care setting, a systematic assessment of the different cognitive domains should be conducted using the Montreal Cognitive Assessment, the MMSE, the Rowland Universal Dementia Assessment, the Addenbrooke's Cognitive Examination, or by means of a stepwise or combined approach involving more simple tests (CDT, TVF, Fototest, MIS, Memory Alteration Test, Eurotest). Associating an informant questionnaire (IQ) with the BCT is superior to the BCT alone for the detection of CI. The choice of instruments will depend on the patient's characteristics, the clinician's experience, and available time. The BCT and IQ must reinforce - but never substitute - clinical judgment, patient-doctor communication, and inter-professional dialogue.
Subject(s)
Cognition Disorders/diagnosis , Cognition Disorders/psychology , Cognition , Neuropsychological Tests , Aged , Aged, 80 and over , Dementia/diagnosis , Female , Humans , Male , Middle Aged , Reproducibility of ResultsABSTRACT
BACKGROUND/AIMS: Little research has been conducted into differences in the perceived quality of life of patients (QoL-p) when comparing spouse and adult child caregivers of people with Alzheimer's disease (AD). The aim of this study was to identify the differential variables in perceived QoL-p between patients and carers, distinguishing between spouse and adult child caregivers. METHOD: Cross-sectional analytic study of 251 patients and their carers (spouses: 112; adult children: 139) using the QoL-AD scale and sociodemographic and clinical data. RESULTS: The more positive perception of spouses was associated with higher educational levels of the caregiver and greater functional autonomy in the patient. The more negative perception of adult children was associated with greater caregiver burden and higher levels of depression in the patient. The perception of daughter caregivers showed the strongest association with mental health and burden. CONCLUSIONS: Spouse caregivers have a more positive perception of the patient's quality of life than adult child caregivers.
