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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)
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Aims of this review
Translating dementia research into practice ©UNSW as represented by the DCRC-ABC (2012)
• pooled prevalence rates of MCI carer outcomes (e.g. depression)
• predictors of MCI carer outcomes
To establish…
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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
Translating dementia research into practice ©UNSW as represented by the DCRC-ABC (2012)
Outcomes considered Measures used
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Prevalence of depressive Sx – general population vs MCI vs dementia carers
Translating dementia research into practice ©UNSW as represented by the DCRC-ABC (2012)
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%
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Depression in dementia carers
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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
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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
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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
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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
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SIGNIFICANT NOT SIGNIFICANT
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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
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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
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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
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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
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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
Translating dementia research into practice ©UNSW as represented by the DCRC-ABC (2012)
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
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© The University of New South Wales, as represented by the Dementia Collaborative Research Centre – Assessment and Better Care (2012).
This work is copyright. You may download, display, print and reproduce this material in unaltered form only (retaining this notice) for your personal, non-commercial use or use within your organisation. Apart from any use as permitted under the Copyright Act 1968, all other rights are reserved. Requests and inquiries concerning reproduction and rights should be addressed to the Dementia Collaborative Research Centre – Assessment and Better Care, University of New South Wales, Sydney NSW 2052 or posted at www.dementiaresearch.org.au
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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.
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Translating dementia research into practice © UNSW as represented by DCRC-ABC (2012)