Physical frailty may exacerbate the behavioral and psychological symptoms of dementia (BSPD) in patients with Alzheimer disease, and also increase caregiver burden, per study data published in the Journal of Clinical Psychiatry.
The study cohort comprised individuals who presented with Alzheimer disease to the Memory Clinic at the National Center for Geriatrics and Gerontology of Japan between October 2010 and February 2015 (N=1193). Alzheimer disease was defined per the criteria of the National Institute on Aging and Alzheimer’s Association workgroups. The Frailty Index (FI) was used to quantify frailty in patients as a ratio of actual deficits to 38 possible deficits. The behavioral and psychological symptoms of dementia and caregiver burden were assessed using the Dementia Behavior Disturbance Scale (DBD) and the Japanese version of Zarit Burden Interview (J-ZBI), respectively. Multiple linear regression analyses and structural equation modeling were performed to examine the relationships among frailty, DBD score, and J-ZBI score.
Study patients were of mean (±SD) age 78.8 (6.3) years, and 68.6% were women. The mean FI Score was 0.16±0.10, with 663 (55.6%) and 198 (16.6%) patients categorized as prefrail (0.08≤FI<0.25) and frail (FI≥0.25), respectively. Participants had a mean DBD score of 16.8±11.3 and a mean J-ZBI score of 21.5±14.9. Per multiple linear regression analyses and structural equation modeling, FI was independently associated with both DBD score and J-ZBI score (each P <.001). When the FI was considered as a categorical variable, prefrailty was also associated with increased DBD score (P <.001) and J-ZBI score (P =.003). The investigators hypothesized that the correlation between higher FI scores and increased caregiver burden was partially mediated by increased BSPD.
These results indicate a strong association between frailty and increased BSPD and caregiver burden. Longitudinal study data are needed to clarify these associations and elucidate potential strategies for reducing BSPD and caregiver burden in Alzheimer disease.
Sugimoto T, Ono R, Kimura A, et al. Physical frailty correlates with behavioral and psychological symptoms of dementia and caregiver burden in Alzheimer’s disease. J Clin Psychiatry. 2018;79(6):17m11991.