Caregiver Burden in Semantic Dementia with Right- and Left-Sided Predominant Cerebral Atrophy and in Behavioral-Variant Frontotemporal Dementia

Abstract

Background: Caregiver burden is a serious concern for family caregivers of dementia patients, but its nature is unclear in patients with semantic dementia (SD). This study aimed to clarify caregiver burden for right- (R > L) and left-sided (L > R) predominant SD versus behavioral-variant frontotemporal dementia (bvFTD) patients.

Methods: Using the Japanese version of the Zarit Burden Interview (ZBI) and the Neuropsychiatric Inventory, we examined caregiver burden and behavioral and psychological symptoms of dementia (BPSD) in 43 first-visit outpatient/family caregiver dyads (bvFTD, 20 dyads; SD [L > R], 13 dyads; SD [R > L], 10 dyads).

Results: We found a significant difference in ZBI score between the 3 diagnostic groups. Post hoc tests revealed a significantly higher ZBI score in the bvFTD than in the SD (L > R) group. The ZBI scores in the SD (L > R) and SD (R > L) groups were not significantly different, although the effect size was large. Caregiver burden was significantly correlated with BPSD scores in all groups and was correlated with activities of daily living and instrumental activities of daily living decline in the bvFTD and SD (R > L) groups.

Conclusion: Caregiver burden was highest in the bvFTD group, comparatively high in the SD (R > L) group, and lowest in the SD (L > R) group. Adequate support and intervention for caregivers should be tailored to differences in caregiver burden between these patient groups.

Keywords: Behavioral and psychological symptoms of dementia; Family caregivers; Frontotemporal lobar degeneration; Zarit Burden Interview.

Fig. 1

Cases of bvFTD, SD (R > L), and SD (L > R). a Representative bvFTD case. A 65-year-old housewife presented with an 8-year history of progressive alterations in her personality and behaviors, such as stereotypy and apathy, and word-finding difficulty. Her MRI revealed circumscribed right-sided dominant frontal lobar atrophy. b Representative SD (R > L) case. A 60-year-old professional man presented with a 2-year history of prosopagnosia, clock-watching or adherence to a strict daily timetable, and increased psychological symptoms, such as apathy and depression. He also showed impairments in word comprehension and naming. His MRI revealed circumscribed bilateral temporal atrophy, which was more marked on the right side. c Representative SD (L > R) case. A 75-year-old female farmer presented with a 3-year history of progressive difficulty in understanding speech and in naming with semantic paraphasia. A strictly fixed daily rhythm that looks like a timetable and psychological symptoms, such as irritability and apathy, were gradually apparent. Her MRI revealed circumscribed bilateral temporal atrophy, which was more marked on the left side. bvFTD, behavioral-variant frontotemporal dementia; SD, semantic dementia; MRI, magnetic resonance imaging.

Fig. 2

Prevalence of BPSD in the 3 diagnostic groups. BPSD, behavioral and psychological symptoms of dementia; bvFTD, behavioral variant frontotemporal dementia; SD, semantic dementia.

Fig. 3

Caregiver burden (ZBI score) in each CDR severity. ZBI, Zarit Burden Interview; CDR, Clinical Dementia Rating; bvFTD, behavioral variant frontotemporal dementia; SD, semantic dementia.