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

Feast, Alexandra; Moniz-Cook, Esme; Stoner, Charlotte; Charlesworth, Georgina; Orrell, Martin


Background: Behavioural and psychological symptoms in dementia (BPSD) are important predictors of institutionalisation 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 wellbeing. Methods: Systematic review and meta-analysis of articles published in English between 1980 and December 2015 reporting which BPSD affect caregiver wellbeing. Article quality was appraised using the Downs and Black Checklist (1998). Results: 40 medium and high quality quantitative articles met the inclusion criteria, 16 were suitable to be included in a meta-analysis of mean distress scores. Depressive behaviours were the most distressing for caregivers followed by agitation/aggression and apathy. Euphoria was the least distressing. Correlation coefficients between mean total behaviour scores and mean distress scores were pooled for 4 studies. Irritability, aberrant motor behaviour and delusions were the most strongly correlated to distress, disinhibition was the least correlated. Conclusion: The evidence is not conclusive as to whether some BPSD impact caregiver wellbeing 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 wellbeing. Future research may benefit from a consistent measure of BPSD, examining BPSD individually, and by examining the causal mechanisms by which BPSD impact wellbeing by including caregiver variables so that interventions can be designed to target BPSD more effectively.

Journal Article Type Article
Publication Date 2016-11
Journal International psychogeriatrics
Print ISSN 1041-6102
Electronic ISSN 1741-203X
Publisher Cambridge University Press (CUP)
Peer Reviewed Peer Reviewed
Volume 28
Issue 11
Pages 1761-1774
Keywords Behavioural and psychological symptoms of dementia (BPSD); Carers; Dementia; Neuropsychiatric symptoms; Quality of life (QoL)
Publisher URL
Copyright Statement ©2017 University of Hull
Additional Information Authors' accepted manuscript of article: Feast, A., Moniz-Cook, E., Stoner, C., Charlesworth, G. and Orrell, M. (2016) ‘A systematic review of the relationship between behavioral and psychological symptoms (BPSD) and caregiver well-being’, International Psychogeriatrics, 28(11), pp. 1761–1774. doi: 10.1017/S1041610216000922.


2016-12-27 13500 Moniz-Cook.pdf (721 Kb)

AM - Accepted Manuscript

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