Exploring the Relationship Between Caregiver Burden and Neuropsychiatric Symptoms in Dementia: A Meta-Regression Analysis
Ana Maria Porto Laxe1, Marianna Leite2, Leonardo Sena1, LuĂ­sa Lara Calazans1, Carolina Moura3, Raquel Q. M. Costa1
1Universidade Federal Fluminense, 2Faculdade Santa Marcelina, 3Hospital Universitário Antonio Pedro
Objective:
To examine the relationship between caregiver burden (Zarit Burden Interview, ZBI), caregiver distress (Neuropsychiatric Inventory-Distress, NPI-D), and neuropsychiatric symptoms (Neuropsychiatric Inventory, NPI total) in dementia patients.
Background:
Managing neuropsychiatric symptoms is crucial for dementia patients, as these symptoms significantly impact both patients and their caregivers. The NPI-D measures the distress caregivers experience due to patients’ neuropsychiatric symptoms, while the ZBI assesses the overall burden on caregivers. Understanding the relationship between caregiver burden, caregiver distress, and the severity of neuropsychiatric symptoms can guide interventions aimed at improving the well-being of both caregivers and patients.
Design/Methods:
Meta-regressions were conducted using data from five studies reporting NPI-D scores and seven reporting ZBI scores. Single-arm meta-analyses for NPI-D, NPI total, and ZBI scores were performed using a random-effects model. A meta-regression was conducted to examine the association between NPI-D scores and NPI total scores.
Results:

The random-effects model estimated a mean ZBI score of 23.76 [95% CI: 14.32 to 33.20, I² = 100%, p = 0]. NPI-D scores had a mean of 10.09 [95% CI: 6.56 to 13.63, I² = 96%, p < 0.01], and the mean NPI total score was 21.84 [95% CI: 19.31 to 24.38, I² = 95%, p < 0.01]. The meta-regression between NPI-D Mean and NPI total showed a statistically significant relationship, with a coefficient of 1.32 [95% CI: 0.97 to 1.68, p = 0.000], indicating a strong association between caregiver distress and neuropsychiatric symptoms.

Conclusions:
Single-arm studies suggest a positive relationship between neuropsychiatric symptoms and caregiver burden. The meta-regression analysis between NPI-D and NPI total demonstrates a significant link between caregiver distress and neuropsychiatric symptoms. Future studies should focus on developing more precise tools that capture caregivers’ daily experiences and challenges to better understand the factors contributing to caregiver burden.
10.1212/WNL.0000000000212585
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