Caregiver burden is increased in Parkinson's disease with mild cognitive impairment (PD-MCI)

Ann J Jones; Roeline G Kuijer; Leslie Livingston; Daniel Myall; Kyla Horne; Michael MacAskill; Toni Pitcher; Paul T Barrett; Tim J Anderson; John C Dalrymple-Alford

doi:10.1186/s40035-017-0085-5

Caregiver burden is increased in Parkinson's disease with mild cognitive impairment (PD-MCI)

Transl Neurodegener. 2017 Jun 19:6:17. doi: 10.1186/s40035-017-0085-5. eCollection 2017.

Authors

Ann J Jones^{1

2}, Roeline G Kuijer², Leslie Livingston^{1

3}, Daniel Myall^{1

3}, Kyla Horne^{1

2

3}, Michael MacAskill^{1

3}, Toni Pitcher^{1

3}, Paul T Barrett^{2

4}, Tim J Anderson^{1

3

5

6}, John C Dalrymple-Alford^{1

2

3

6}

Affiliations

¹ New Zealand Brain Research Institute, 66 Stewart Street, Christchurch, 8011 New Zealand.
² Department of Psychology, University of Canterbury, Christchurch, New Zealand.
³ Department of Medicine, University of Otago, Christchurch, New Zealand.
⁴ Cognadev, UK Ltd., Sandton, South Africa.
⁵ Department of Neurology, Christchurch Hospital, Christchurch, New Zealand.
⁶ Brain Research New Zealand Centre of Research Excellence, Christchurch, New Zealand.

Abstract

Background: There is limited evidence on caregiver outcomes associated with mild cognitive impairment in patients with Parkinson's disease (PD-MCI) and the coping strategies used by these caregivers.

Methods: To investigate this relationship, we examined levels of burden, depression, anxiety, coping strategies and positive aspects of caregiving in the informal caregivers of 96 PD patients. The PD patients were classified using MDS-Task Force Level II criteria as showing either normal cognition (PD-N; n = 51), PD-MCI (n = 30) or with dementia (PDD; n = 15).

Results: Mean Zarit Burden Interview (ZBI) score increased significantly between carers of PD-N (M = 13.39, SD = 12.22) compared to those of PD-MCI patients (M = 22.00, SD = 10.8), and between carers of PD-MCI and PDD patients (M = 29.33, SD = 9.59). Moreover, the proportion of carers showing clinically significant levels of burden (ZBI score ≥ 21) also increased as the patients' cognitive status declined (18% for PD-N; 60% for PD-MCI; and 80% for PDD) and was mirrored by an increasing amount of time spent providing care by the caregivers. Caregiver ZBI score was independent of patient neuropsychiatric symptoms, motor function, disease duration and time that caregivers spent caregiving. Caregiver use of different coping strategies increased with worsening cognition. However, we found only equivocal evidence that the use of problem-focused, emotion-focused and dysfunctional coping mediated the association between patient cognitive status and caregiver burden, because the inverse models that used caregiver burden as the mediator were also significant.

Conclusions: The study highlights the impact of Parkinson's disease on those providing care when the patient's cognition is poor, including those with MCI. Caregiver well-being has important implications for caregiver support, nursing home placement and disease course.

Keywords: Anxiety; Coping; Depression; Mild cognitive impairment; Parkinson’s disease; Positive aspects of caregiving; Zarit caregiver burden interview.