Effects of Inappropriate Sexual Behaviors and Neuropsychiatric Symptoms of Patients With Alzheimer Disease and Caregivers’ Depression on Caregiver Burden
Restricted accessResearch articleFirst published online September, 2020
Effects of Inappropriate Sexual Behaviors and Neuropsychiatric Symptoms of Patients With Alzheimer Disease and Caregivers’ Depression on Caregiver Burden
We investigated the effects of inappropriate sexual behaviors (ISBs) and neuropsychiatric symptoms (NPSs) of patients with Alzheimer disease (AD), and of caregivers’ depression, on the caregiver burden.
Method:
One hundred forty three patients with AD and their caregivers were included in the study. Sixty-five patients without AD who needed care due to their disability and their caregivers were enrolled for the comparison. Depression in caregivers was diagnosed using The Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (SCID-I). The Mini-Mental State Examination (MMSE) and Clinical Dementia Rating Scale were used to evaluate the severity of AD. The Neuropsychiatric Inventory (NPI) was used to assess the NPSs of patients. Caregiver burden was evaluated using the Zarit Burden Interview (ZBI).
Results:
Inappropriate sexual behaviors were found in 13 (9.1%) of the AD group. Inappropriate sexual behaviors were more common in moderate or severe AD (P = .009, χ2 = 9.396). The prevalence of depression (n = 38, 26.6%) was higher in caregivers of AD group with ISBs (P = .000, χ2 = 24.69). The ZBI scores of caregivers of patients with AD were higher than the comparison group. In addition, the ZBI scores of caregivers of patients with AD were significantly higher in the AD group with ISB, a high total score of NPI, and a low score of MMSE. The caregivers of AD group with depression had higher ZBI scores (P < .05).
Conclusions:
The severity of AD, the presence of NPSs in patients, and major depression in caregivers were risk factors for an increased caregiver burden.
KlimovaBMaresovaPValisMHortJKucaK. Alzheimer’s disease and language impairments: social intervention and medical treatment. Clin Interv Aging. 2015;10:1401–1407.
2.
PudelewiczATalarskaDBaczykG. Burden of caregivers of patients with Alzheimer’s disease. Scand J Caring Sci. 2019;33(2):336–341.
3.
PrinceMBryceRAlbaneseEWimoARibeiroWFerriCP. The global prevalence of dementia: a systematic review and metaanalysis. Alzheimers Dement. 2013;9(1):63–75. e62.
4.
ChenPGuarinoPDDyskenMW, et al.Neuropsychiatric symptoms and caregiver Burden in individuals with Alzheimer’s disease: the TEAM-AD VA Cooperative Study. J Geriatr Psychiatry Neurol. 2018;31(4):177–185.
5.
LyketsosCGCarrilloMCRyanJM, et al.Neuropsychiatric symptoms in Alzheimer’s disease. Alzheimers Dement. 2011;7(5):532–539.
6.
GedaYERobertsROKnopmanDS, et al.Prevalence of neuropsychiatric symptoms in mild cognitive impairment and normal cognitive aging: population-based study. Arch Gen Psychiatry. 2008;65(10):1193–1198.
7.
SteffensDCMaytanMHelmsMJPlassmanBL. Prevalence and clinical correlates of neuropsychiatric symptoms in dementia. Am J Alzheimers Dis Other Demen. 2005;20(6):367–373.
8.
OkuraTPlassmanBLSteffensDCLlewellynDJPotterGGLangaKM. Prevalence of neuropsychiatric symptoms and their association with functional limitations in older adults in the United States: The Aging, Demographics, and Memory Study. J Am Geriatr Soc. 2010;58(2):330–337.
9.
BenoitMRobertPHStacciniP, et al.One-year longitudinal evaluation of neuropsychiatric symptoms in Alzheimer’s disease. The REAL.FR Study. J Nutr Health Aging. 2005;9(2):95–99.
10.
AllegriRFSarasolaDSerranoCM, et al.Neuropsychiatric symptoms as a predictor of caregiver burden in Alzheimer’s disease. Neuropsychiatr Dis Treat. 2006;2(1):105–110.
11.
PetersMESchwartzSHanD, et al.Neuropsychiatric symptoms as predictors of progression to severe Alzheimer’s dementia and death: the Cache County Dementia Progression Study. Am J Psychiatry. 2015;172(5):460–465.
12.
TootSSwinsonTDevineMChallisDOrrellM. Causes of nursing home placement for older people with dementia: a systematic review and meta-analysis. Int Psychogeriatr. 2017;29(2):195–208.
13.
OkuraTLangaKM. Caregiver burden and neuropsychiatric symptoms in older adults with cognitive impairment: The Aging, Demographics, and Memory Study (ADAMS). Alzheimer Dis Assoc Disord. 2011;25(2):116–121.
14.
BergerGBernhardtTWeimerEPetersJKratzschTFrolichL. Longitudinal study on the relationship between symptomatology of dementia and levels of subjective burden and depression among family caregivers in memory clinic patients. J Geriatr Psychiatry Neurol. 2005;18(3):119–128.
15.
DauphinotVRavierANovaisTDelphin-CombeFMouchouxCKrolak-SalmonP. Risk factors of caregiver Burden evolution, for patients with subjective cognitive decline or neurocognitive disorders: a longitudinal analysis. J Am Med Dir Assoc. 2016;17(11):1037–1043.
16.
Conde-SalaJLTurro-GarrigaOCalvo-PerxasLVilalta-FranchJLopez-PousaSGarre-OlmoJ. Three-year trajectories of caregiver burden in Alzheimer’s disease. J Alzheimers Dis. 2014;42(2):623–633.
17.
Aguera OrtizLLopez AlvarezJ. Mild behavioral impairment: a new concept for the prodromic phases of dementia [in Spanish]. Rev Esp Geriatr Gerontol. 2017;52(Suppl 1):24–27.
18.
CanevelliMLucchiniFGarofaloC, et al.Inappropriate sexual behaviors among community-dwelling patients with dementia. Am J Geriatr Psychiatry. 2017;25(4):365–371.
19.
OnishiJSuzukiYUmegakiH, et al.Behavioral, psychological and physical symptoms in group homes for older adults with dementia. Int Psychogeriatr. 2006;18(1):75–86.
20.
CiprianiGUliviMDantiSLucettiCNutiA. Sexual disinhibition and dementia. Psychogeriatrics. 2016;16(2):145–153.
21.
De GiorgiRSeriesH. Treatment of inappropriate sexual behavior in dementia. Curr Treat Options Neurol. 2016;18(9):41.
22.
TsaiSJHwangJPYangCHLiuKMLirngJF. Inappropriate sexual behaviors in dementia: a preliminary report. Alzheimer Dis Assoc Disord. 1999;13(1):60–62.
23.
AlkhalilCTanvirFAlkhalilBLowenthalDT. Treatment of sexual disinhibition in dementia: case reports and review of the literature. Am J Ther. 2004;11(3):231–235.
24.
LevitskyAMOwensNJ. Pharmacologic treatment of hypersexuality and paraphilias in nursing home residents. J Am Geriatr Soc. 1999;47(2):231–234.
25.
MillerBLCummingsJLMcIntyreHEbersGGrodeM. Hypersexuality or altered sexual preference following brain injury. J Neurol Neurosurg Psychiatry. 1986;49(8):867–873.
26.
AlagiakrishnanKLimDBrahimA, et al.Sexually inappropriate behaviour in demented elderly people. Postgrad Med J. 2005;81(957):463–466.
27.
McKhannGMKnopmanDSChertkowH, et al.The diagnosis of dementia due to Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement. 2011;7(3):263–269.
28.
FirstMBWilliams JanetBWSpitzerRLGibbonM. Structured Clinical Interview For DSM-IV Clinical Version (SCID-I/CV). Washington, DC: American Psychiatric Press; 1997.
29.
BeckATWardCHMendelsonMMockJErbaughJ. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561–571.
30.
HisliN. Beck depresyon envanterinin geçerliği üzerine bir çalişma. Psikoloji Dergisi. 1988;22(6):118–126.
31.
ZaritSHReeverKEBach-PetersonJ. Relatives of the impaired elderly: correlates of feelings of burden. Gerontologist. 1980;20(6):649–655.
32.
InciHFErdemM. Bakım Verme Yükü Ölçeği’nin Türkçe’ye Uyarlanması Geçerlilik ve Güvenilirliği. Atatürk Üniversitesi Hemşirelik Yüksekokulu Dergisi. 2008;11(4):85–89.
33.
FolsteinMFFolsteinSEMcHughPR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–198.
34.
MorrisJC. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology. 1993;43(11):2412–2414.
35.
CummingsJLMegaMGrayKRosenberg-ThompsonSCarusiDAGornbeinJ. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology. 1994;44(12):2308–2314.
36.
IsikATSoysalPSolmiMVeroneseN. Bidirectional relationship between caregiver burden and neuropsychiatric symptoms in patients with Alzheimer’s disease: a narrative review. Int J Geriatr Psychiatry. 2019;34(9):1326–1334.
37.
BardellALauTFedoroffJP. Inappropriate sexual behavior in a geriatric population. Int Psychogeriatr. 2011;23(7):1182–1188.
38.
SzaszG. Sexual incidents in an extended care unit for aged men. J Am Geriatr Soc. 1983;31(7):407–411.
39.
BlackBMuraleeSTampiRR. Inappropriate sexual behaviors in dementia. J Geriatr Psychiatry Neurol. 2005;18(3):155–162.
40.
TorrisiMCacciolaAMarraADe LucaRBramantiPCalabroRS. Inappropriate behaviors and hypersexuality in individuals with dementia: an overview of a neglected issue. Geriatr Gerontol Int. 2017;17(6):865–874.
41.
BirdMMoniz-CookE. Challenging behaviour in dementia: a psychosocial approach to intervention. In: WoodsBClareL, eds. Handbook of the Clinical Psychology of Ageing. 2nd ed. New York, NY: John Wiley & Sons; 2008:571–594.
42.
ZuidemaSKoopmansRVerheyF. Prevalence and predictors of neuropsychiatric symptoms in cognitively impaired nursing home patients. J Geriatr Psychiatry Neurol. 2007;20(1):41–49.
43.
ChengST. Dementia Caregiver Burden: a research update and critical analysis. Curr Psychiatry Rep. 2017;19(9):64.
44.
RielloRGeroldiCZanettiOFrisoniGB. Caregiver’s distress is associated with delusions in Alzheimer’s patients. Behav Med Fall. 2002;28(3):92–98.
45.
Lima-SilvaTBBahiaVSCarvalhoVA, et al.Neuropsychiatric symptoms, caregiver burden and distress in behavioral-variant frontotemporal dementia and Alzheimer’s disease. Dement Geriatr Cogn Disord. 2015;40(5–6):268–275.
46.
SousaMFSantosRLTurro-GarrigaODiasRDouradoMCConde-SalaJL. Factors associated with caregiver burden: comparative study between Brazilian and Spanish caregivers of patients with Alzheimer’s disease (AD). Int Psychogeriatr. 2016;28(8):1363–1374.
47.
FuhJLLiuCKMegaMSWangSJCummingsJL. Behavioral disorders and caregivers’ reaction in Taiwanese patients with Alzheimer’s disease. Int Psychogeriatr. 2001;13(1):121–128.
48.
GehrmanPGooneratneNSBrewsterGSRichardsKCKarlawishJ. Impact of Alzheimer disease patients’ sleep disturbances on their caregivers. Geriatr Nurs. 2018;39(1):60–65.
49.
KasuyaRTPolgar-BaileyPTakeuchiR.Caregiver burden and burnout. A guide for primary care physicians. Postgrad Med. 2000;108(7):119–123.
50.
AlmbergBJanssonWGrafstromMWinbladB. Differences between and within genders in caregiving strain: a comparison between caregivers of demented and non-caregivers of non-demented elderly people. J Adv Nurs. 1998;28(4):849–858.
51.
GallicchioLSiddiqiNLangenbergPBaumgartenM. Gender differences in burden and depression among informal caregivers of demented elders in the community. Int J Geriatr Psychiatry. 2002;17(2):154–163.
52.
AnnerstedtLElmstahlSIngvadBSamuelssonSM. Family caregiving in dementia—an analysis of the caregiver’s burden and the “breaking-point” when home care becomes inadequate. Scand J Public Health. 2000;28(1):23–31.
53.
ChumblerNRGrimmJWCodyMBeckC. Gender, kinship and caregiver burden: the case of community-dwelling memory impaired seniors. Int J Geriatr Psychiatry. 2003;18(8):722–732.
54.
VolicerL. Caregiver burden in dementia care: prevalence and health effects. Curr Psychosis Ther Rep. 2005;3(1):20–25.
55.
CovinskyKENewcomerRFoxP, et al.Patient and caregiver characteristics associated with depression in caregivers of patients with dementia. J Gen Intern Med. 2003;18(12):1006–1014.
56.
HarwoodDGBarkerWWCantillonMLoewensteinDAOwnbyRDuaraR. Depressive symptomatology in first-degree family caregivers of Alzheimer disease patients: a cross-ethnic comparison. Alzheimer Dis Assoc Disord. 1998;12(4):340–346.
