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DEMENTIA RESEARCH

Translating dementia research into practice

Negative outcomes for MCI caregivers – Evidence form a systematic literature

review

Katrin Seeher, Lee-Fay Low, Simone Reppermund and Henry BrodatyDementia Collaborative Research Centre – Assessment and Better Care

Brain and Ageing Research Program, University of New South Wales

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Background

• Mild Cognitive Impairment (MCI) has become focus of research– Potential prodromal stage of dementia– Biomarker research– Early interventions/prevention

• Can the same paradigm be used for caregivers?

Translating dementia research into practice ©UNSW as represented by the DCRC-ABC (2012)


Aims of this review


• pooled prevalence rates of MCI carer outcomes (e.g. depression)

• predictors of MCI carer outcomes

To establish…


Ψ outcomes in MCI carers - A systematic literature review

• Medline, EMBASE, Scopus, Cochrane, PubMed, PsycInfo, CINAHL

• abstracts and titles screened of 266 articles

• 76 accessed in full-text• 10 included in review


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Caregiver outcomes considered

• Depression

most results• Burden• Anxiety• Quality of Life

• CES-D, GDS-S

• ZBS, ZBI• STAI-S• SF-36


Outcomes considered Measures used


Prevalence of depressive Sx – general population vs MCI vs dementia carers


MCI carers Dementia carers Schoenmaker et al (2010)

General population

Pooled prevalence

23%

(11% - 24.6%) 19.7% - 39%

5 studies929 carers

14% - 19%or

9% - 19%


Depression in dementia carers


Mea

n C

ES

-D s

core

MCI carers, pooled data over 4 studies (total N=872)

Dementia carer cohorts included in Schoenmaker et al (2010)

Pop. norm+ older community cohorts


Other ψ outcomes in MCI carers

• ? Higher levels of – Burden: ZBI≥21 = 31.4% (Bruce et al., 2008)

– Stress: RSS>30 = 10.5% (Rosness et al, 2009)

– Anxiety: STAI-S>44 = 11% (Garand et al, 2005)

• ? Quality of Life (QoL) (McIllvane et al, 2008)

– Mean SF-36 (M) = 51.0 (SD 9.7)– Mean SF-36 (P) = 44.8 (SD 11.2)


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Predictors of depression in MCI carers



Predictors of depressive Sx• 3 studies (MCI samples only); 28 predictors in

total• 5 predictors included by more than one study

– Carers’ age n.s.

– Carers’ education sig (2/3) β=-0.36 and β=-1.97

– Relationship to patient n.s.

– Behavioural Sx sig (1/2) β=1.98

– Subjective burden sig (1/2) β=3.24


Blieszner et al (2010), Garand et al (2005) and Lu et al (2007)

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Other predictors analysed by single studies

• Physical health• Relational deprivation• Importance of religion• Dementia knowledge• Mastery• Coping• Social support

• Patient demographics• Carer demographics (not age)

• Carer expectations re aging• Service attitudes• Patients’ cog. function• ADLs/IADLs• Lifestyle constraints• Self-loss• Personal gain


SIGNIFICANT NOT SIGNIFICANT


Summary of findings in a nutshell

• Depressive Sx most widely studied in MCI carers

• Intermediate stage between NCI and dementia carers

• Some evidence for existing caregiver stress models also being valid in context of MCI carers



What are the limitations to date? - general

• Only very few studies to date• Only single studies report on carer

outcomes such as burden, stress, anxiety

• Small n, often lacking controls• Inconsistent methodology/use of

outcome measures• All studies to date cross-sectional



What are the limitations to date? – owed to the concept of MCI

• Lack of variability in predictors due to low rates of cognitive, functional or behavioural impairment in MCI

• Is there a differential effect of MCI subtypes?

• MCI ≠ one way street



What are the limitations to date? – due to selection bias

• Clinical samples only i.e. not pre-symptomatic!– Help seeking might reflect higher

symptomatology in this population– Largest proportion of carers took part in RCT

for donepezil vs vitamin E in aMCI• Majority were spouses• Publication bias



Conclusions

• Best evidence for depressive Sx• These early carers are at high risk for psych

distress and burden• More research into stress processes in MCI

carers is warranted• Longitudinal population-based studies are

needed


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AcknowledgementsSupervisors• Prof Henry Brodaty• Dr Lee-Fay Low• Dr Simone Reppermund

Research students• Mira Ertl• William Zhang• Julia Mueller


Seeher K, Low LF, Reppermund S and Brodaty H: Predictors and outcomes for caregivers of people with MCI – A systematic literature

review. Alzheimer’s and Dementia (in press) doi:10.1016/j.jalz.2012.01.012

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Dementia. Dementia. WhoWho gets it? gets it?2012 National Dementia Research Forum

Canberra, Australia27-28 September, 2012

??Translating dementia research into practice ©UNSW as represented by the DCRC-ABC (2012)

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© The University of New South Wales, as represented by the Dementia Collaborative Research Centre – Assessment and Better Care (2012).

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Copyright Statement

Translating dementia research into practice © UNSW as represented by DCRC-ABC (2012)

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The views expressed in this work are the views of its authors and not necessarily those of the Commonwealth of Australia. The reader needs to be aware that the information in this work is not necessarily endorsed, and its contents may not have been approved or reviewed by the Australian Government.

Disclaimer

Translating dementia research into practice © UNSW as represented by DCRC-ABC (2012)

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