I have the impression that dementia research is mainly focused on early diagnosis, new anti-amyloid therapies and prevention, which are truly outstanding areas. The article of Skoda et al.,Reference Skoda, Conant and Couture1 however, highlights an issue that clinicians must never forget: neuropsychiatric symptoms (NPS) are responsible for the major burden for caregivers and people living with dementia (PLWD).Reference Chen, Sung and Wang2 Consequently, research aiming to understand determinants, characteristics and evolution of NPS and plan strategies to reduce burden is welcome. Non-pharmacological strategies are the first line of intervention for NPSReference Bessey and Walaszek3,Reference Tampi and Jeste4 : only a few drugs are useful according to randomized clinical trials, and drugs may have severe side effects.Reference Tampi and Jeste4 Not surprisingly, in Skoda and coauthors’ study, psychotic behaviors, affective and hyperactivity symptoms and sleep disturbances are associated with greater distress.Reference García-Martín, de Hoyos-Alonso, Delgado-Puebla, Ariza-Cardiel and Del Cura-González5 Less expectedly, only mood symptoms, disinhibition and sleep disturbances predict prolonged high burden at 6 months follow-up. For the first series of symptoms, a combined pharmacological and non-pharmacological approach for PLWD and supportive intervention for caregivers can therefore be required. For symptoms causing prolonged distress, a careful and above all sustainable planning of caregivers’ support could be particularly relevant. Skoda et al. also analyze differences in caregiving burden between sexes: female caregivers appear to be most affected by psychotic symptoms and sleep disturbances and male caregivers by mood symptoms. The authors address this point in discussion: although these findings may be influenced by different sex incidence in various dementia forms, they may also be shaped by other sex-linked factors. Mood disorders are highly prevalent in women,Reference Altemus, Sarvaiya and Neill Epperson6 who have been culturally allowed to freely express their emotions. They could therefore be more accustomed to coping with anxiety and depression. However, they can be less able to manage psychotic or agitation symptoms, which are perceived as less distressing by men, who are more accustomed to using rational strategies to cope. These symptoms may also elicit fear of potential physical aggression in women. Understanding gender differences in coping strategies could help plan the right intervention to support caregivers and reduce NPS (skills in caregiving can reduce NPS.Reference Altemus, Sarvaiya and Neill Epperson6) Further studies should explore other characteristics affecting coping strategies, for example, ethnocultural differences and sociocultural levels. Finally, the article of Skoda et al. leaves unexplored a difficult but relevant topic: differences in caregiving when the person with dementia is a young one.
I have the impression that dementia research is mainly focused on early diagnosis, new anti-amyloid therapies and prevention, which are truly outstanding areas. The article of Skoda et al.,Reference Skoda, Conant and Couture1 however, highlights an issue that clinicians must never forget: neuropsychiatric symptoms (NPS) are responsible for the major burden for caregivers and people living with dementia (PLWD).Reference Chen, Sung and Wang2 Consequently, research aiming to understand determinants, characteristics and evolution of NPS and plan strategies to reduce burden is welcome. Non-pharmacological strategies are the first line of intervention for NPSReference Bessey and Walaszek3,Reference Tampi and Jeste4 : only a few drugs are useful according to randomized clinical trials, and drugs may have severe side effects.Reference Tampi and Jeste4 Not surprisingly, in Skoda and coauthors’ study, psychotic behaviors, affective and hyperactivity symptoms and sleep disturbances are associated with greater distress.Reference García-Martín, de Hoyos-Alonso, Delgado-Puebla, Ariza-Cardiel and Del Cura-González5 Less expectedly, only mood symptoms, disinhibition and sleep disturbances predict prolonged high burden at 6 months follow-up. For the first series of symptoms, a combined pharmacological and non-pharmacological approach for PLWD and supportive intervention for caregivers can therefore be required. For symptoms causing prolonged distress, a careful and above all sustainable planning of caregivers’ support could be particularly relevant. Skoda et al. also analyze differences in caregiving burden between sexes: female caregivers appear to be most affected by psychotic symptoms and sleep disturbances and male caregivers by mood symptoms. The authors address this point in discussion: although these findings may be influenced by different sex incidence in various dementia forms, they may also be shaped by other sex-linked factors. Mood disorders are highly prevalent in women,Reference Altemus, Sarvaiya and Neill Epperson6 who have been culturally allowed to freely express their emotions. They could therefore be more accustomed to coping with anxiety and depression. However, they can be less able to manage psychotic or agitation symptoms, which are perceived as less distressing by men, who are more accustomed to using rational strategies to cope. These symptoms may also elicit fear of potential physical aggression in women. Understanding gender differences in coping strategies could help plan the right intervention to support caregivers and reduce NPS (skills in caregiving can reduce NPS.Reference Altemus, Sarvaiya and Neill Epperson6) Further studies should explore other characteristics affecting coping strategies, for example, ethnocultural differences and sociocultural levels. Finally, the article of Skoda et al. leaves unexplored a difficult but relevant topic: differences in caregiving when the person with dementia is a young one.
Competing interests
Previous coordinator of the NPS study group of the Italian Dementia Neurological Society.