The featured paper is ‘Impact of Frontal Systems Behavioural Functioning in Dementia on Caregiver Burden’ by Jennifer Davis and Geoffrey Tremont and freely available here.
The authors were interested in looking at the effect of frontal lobe related behaviours in people with dementia on caregivers. The frontal lobe related behaviours were ‘apathy, executive dysfunction and disinhibition’. The participants were caregivers for people with mild and moderate dementia. I wasn’t able to find the characteristics of the caregivers however other than to see that a majority were caucasian, spouses and female. Tabulated results for caregiver characteristics would be quite useful in working out how applicable the results are to different populations. The severity of dementia was measured using the Clinical Dementia Rating Scale administered to the caregiver over the telephone while diagnosis was established by the physician. Such an approach means that the caregiver in effect is making the diagnosis as their impressions of the person’s abilities in judgement, memory and problem solving are forming the basis for marking. Nevertheless the caregivers may not necessarily have the training to accurately assess these characteristics. A direct assessment of the care recipient’s cognition would have provided useful data for estimating illness severity although it would have involved a significant adaptation of the study with more resources (the researcher would have needed to travel to see the care recipient or else arranged for them to attend a clinic. However in a later part of the study interviews are conducted at the caregivers homes in any case). Most of the care recipients had received a diagnosis of Alzheimer’s Disease with relatively few diagnosed with mixed and vascular dementia which suggests this isn’t representative of the proportion of dementias in the general population (i.e. Alzheimer’s Disease is perhaps over-represented in this group). Perhaps a larger sample of people with frontotemporal dementia might have been more relevant in examining the relationship between frontal type behaviours and caregiver burden. Again in the interview at the caregivers home, the tests are administerd to the caregiver including the Frontal Systems Behaviour Scale. It might have been useful to obtain some information from the care recipient.
A hierarchical regression analysis on the relationship between frontal behaviours and perceived burden was conducted which controlled for depression, activities of daily living as well as baseline care recipients personality measures. Caregiver burden was significantly associated with depression scores (p<0.01) and frontal behavioural measures (p<0.05). In particular, executive dysfunction and disinhibition contributed to burden scores on the burden interview. The finding of a relationship between caregiver burden and baseline functioning was interesting as the authors pointed out and may be important to the premorbid relationship between caregiver and care recipient. The authors suggest a longitudinal study to explore the findings further and this seems reasonable. They also point out that psychometric assessments should be conducted on the care recipients directly as suggested above. The researchers have generated testable hypotheses which are clinically relevant and could inform therapeutic approaches.
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