Review: Behavioral Symptoms and Caregiver Burden in Dementia

The paper reviewed is ‘Behavioral Symptoms and Caregiver Burden in Dementia’ by Shaji and colleagues and freely available here.

Aims: The authors write that

The present study examines the prevalence of BPSD in a community sample of patients with dementia and its impact on the caregivers

Method: The study took place in a rural area in Kerala, India. Trained healthworkers identified cases which were then screened by clinicians using DSM-IV criteria and the Clinical Dementia Rating (CDR) scale. Subjects rated as moderate to severe on the CDR were included in the study. I didn’t notice any exclusion criteria and the population might therefore be representative of a clinical population (albeit with selection bias influencing the sample population characteristics). The subjects were also included in two other studies and three outcome measures were collected

  • General Health Questionnaire-12.
  • Zaret Burden Interview (ZBI).

The statistical tests used for different data types are clearly stated.


  • 29 people were included in the study with a mean age of 78.3 and all living at home with their families.
  • The characteristics of the sample are described in table 1. 43.8% of the people received a diagnosis of Alzheimer’s Disease and 34.5% were diagnosed with Vascular Dementia. The other diagnosis or combinations are described. 79.3% of the sample were female.
  • The scores on BEHAVE-AD are described in table 2 with 28 of the subjects meeting the criteria for Behavioural and Psychological Symptoms in Dementia (BPSD). I noted that the standard deviations were relatively large.
  • Table 3 displays the prevalence of items on the BEHAVE-AD subscales. Particularly prominent are delusional ideation and disturbances of activity.
  • In Table 4 the researchers detail the incidence of delusion types.
  • Table 5 shows a comparison of vascular dementia and Alzheimer’s Disease.
  • Table 6 showed the characteristics of no/mild BEHAVE-AD symptoms v moderate/severe BEHAVE-AD symptoms. Here, I thought the significant results perhaps reflected their relationship to the BEHAVE-AD total as they are components.
  • Table 7 displayed the characteristics of 2 samples defined by GHQ score thresholds. There is a significant relationship between increasing GHQ scores and ZBI scores. I thought that causality might be difficult to interpret in view of the cross-sectional nature of the study.


The authors draw a number of conclusions. They note the absence of a relationship between BEHAVE-AD and GHQ-12 scores and suggest that a larger sample size may be helpful in exploring this relationship further.


I thought this was a small but interesting study in a sample with family based care of people with moderate to severe dementia. There was found to be an association between GHQ scores in carers and ZBI scores although the direction of the link was unclear given the cross-sectional design of this study.

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