A systematic review of the relationship between behavioral and psychological symptoms (BPSD) and caregiver well-being

Int Psychogeriatr. 2016 Nov;28(11):1761-1774. doi: 10.1017/S1041610216000922. Epub 2016 Jun 27.


Background: Behavioral and psychological symptoms in dementia (BPSD) are important predictors of institutionalization as well as caregiver burden and depression. Previous reviews have tended to group BPSD as one category with little focus on the role of the individual symptoms. This review investigates the role of the individual symptoms of BPSD in relation to the impact on different measures of family caregiver well-being.

Methods: Systematic review and meta-analysis of papers published in English between 1980 and December 2015 reporting which BPSD affect caregiver well-being. Paper quality was appraised using the Downs and Black Checklist (1998).

Results: Forty medium and high quality quantitative papers met the inclusion criteria, 16 were suitable to be included in a meta-analysis of mean distress scores. Depressive behaviors were the most distressing for caregivers followed by agitation/aggression and apathy. Euphoria was the least distressing. Correlation coefficients between mean total behavior scores and mean distress scores were pooled for four studies. Irritability, aberrant motor behavior and delusions were the most strongly correlated to distress, disinhibition was the least correlated.

Conclusions: The evidence is not conclusive as to whether some BPSD impact caregiver well-being more than others. Studies which validly examined BPSD individually were limited, and the included studies used numerous measures of BPSD and numerous measures of caregiver well-being. Future research may benefit from a consistent measure of BPSD, examining BPSD individually, and by examining the causal mechanisms by which BPSD impact well-being by including caregiver variables so that interventions can be designed to target BPSD more effectively.

Keywords: behavioral and psychological symptoms of dementia; carer; dementia; neuropsychiatric symptoms; quality of life.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Behavioral Symptoms
  • Caregivers / psychology*
  • Cost of Illness*
  • Dementia* / psychology
  • Dementia* / therapy
  • Depression* / diagnosis
  • Depression* / prevention & control
  • Depression* / psychology
  • Emotional Adjustment
  • Humans
  • Mental Health
  • Quality of Life*
  • Social Support