Behavioral and psychological symptoms of dementia

Behavioral and psychological symptoms of dementia (BPSD) encompass a diverse range of neuropsychiatric behaviors and symptoms, such as agitation, anxiety, depression, and apathy, commonly observed in older adults with dementia (Cerejeira et al., 2012). BPSD can increase dementia caregiver burden, which may potentially affect caregiver well-being. In a systematic review, anger/aggression and depression were most frequently identified symptoms associated with caregiver burden (Ornstein & Gaugler, 2012). According to Feast et al. (2016), communication changes caused by BPSD in people living with dementia also contribute substantially to caregiver burden, making previously enjoyable conversations with family caregivers difficult or, in severe cases, leading to a complete lack of interaction. However, it remains unclear whether BPSD heightens negative caregiving appraisal and, in turn, strengthens the association between caregiver burden and adverse mental health outcomes.

It is important to note that while BPSD include a wide spectrum of behaviors and symptoms, these tend to co-occur and mutually reinforce one another. For this reason, BPSD have been examined at the group rather than the individual symptom level using data reduction techniques (Van Der Linde et al., 2014). For example, using factor analysis, Kim et al. (2021) found factors related to hyperactivity symptoms, psychosis symptoms, and physical behavior symptoms associated with BPSD, with each of these factors showing a significant direct effect on caregiver burden.

Although previous studies have consistently demonstrated a significant positive association between BPSD and caregiver burden (Pinquart & Sörensen, 2003), there is limited understanding of the interaction between caregiver burden and BPSD in relation to caregivers’ mental health. A more detailed understanding of how BPSD interact with caregiver burden can help identify more vulnerable subgroups, which in turn can help both manage caregiving expectations and provide targeted support where it is likely most needed. BPSD symptoms may be especially burdensome for Puerto Rican dementia caregivers, who often navigate these challenges in cultural contexts that prioritize family obligation over formal care (Yeo & Gallagher-Thompson, 2014). This may lead to greater reliance on family support and reduced use of professional mental health services, even when specialized care is needed.