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Armstrong MJ, Dai Y, Sovich K, LaBarre B, Paulson HL, Maixner SM, Fields JA, Lunde AM, Forsberg LK, Boeve BF, Manning CA, Galvin JE, Taylor AS, Li Z. Caregiver Experiences and Burden in Moderate-Advanced Dementia With Lewy Bodies. Neurol Clin Pract 2024; 14:e200292. [PMID: 38617555 PMCID: PMC11014644 DOI: 10.1212/cpj.0000000000200292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/23/2024] [Indexed: 04/16/2024]
Abstract
Background and Objectives Dementia with Lewy bodies (DLB) is a common degenerative dementia, but research on caregiver experiences in late stages is lacking. This study aimed to investigate the caregiving experience in moderate-advanced DLB to identify opportunities for improving care and support. Methods Dyads of individuals with moderate-advanced DLB and their primary informal caregivers were recruited from specialty clinics, advocacy organizations, and research registries. The study collected demographics, disease-related measures, and measures of the caregiver experience relating to caregiver support, burden, grief, self-efficacy, depression, quality of life, and coping. Spearman correlation coefficients and Wilcoxon rank-sum tests evaluated the relationships of caregiver measures with patient and caregiver variables with adjustments for multiple testing. Results Caregivers (n = 143) were mostly women (83.5%) and spouses (84.7%) (mean age 68 years; range 37-85). Almost 40% reported high burden and/or depression. Caregiver measures correlated with fluctuation and behavioral symptom severity, sleepiness, and autonomic symptoms of the person with DLB. Higher burden correlated with worse caregiver quality of life, higher depression, and grief. Greater self-efficacy, social support, and resilience correlated with lower caregiver burden. The most frequently reported caregiver concerns were being unable to plan for the future, having to put the needs of the person with DLB ahead of the caregiver's own needs, and worry that the person with DLB would become too dependent on the caregiver, but many additional concerns were endorsed. Caregivers were generally satisfied with medical team support. The lowest reported satisfaction related to information regarding disease progression and how well medical teams shared information with each other. Discussion Various patient-related and caregiver-related factors influence caregiver experiences in moderate-advanced DLB. Clinicians can target caregiver needs by providing support resources and DLB education and treating bothersome patient symptoms. Future research should investigate what interventions can modify and improve caregiver experiences in advanced DLB and identify therapeutics for patient symptoms currently without adequate treatments (e.g., fluctuations, daytime sleepiness). Trial Registration Information NCT04829656.
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Affiliation(s)
- Melissa J Armstrong
- Department of Neurology (MJA, KS), University of Florida College of Medicine; Norman Fixel Institute for Neurological Diseases (MJA); Department of Biostatistics (YD, BL, ZL), University of Florida College of Medicine, Gainesville; Departments of Neurology (HLP) and Psychiatry (SMM), University of Michigan, Ann Arbor; Departments of Psychiatry and Psychology (JAF) and Neurology (AML, LKF, BFB), Mayo Clinic Rochester, MN; Department of Neurology (CAM), University of Virginia, Charlottesville; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, FL; and Lewy Body Dementia Association (AST), Lilburn, GA
| | - Yunfeng Dai
- Department of Neurology (MJA, KS), University of Florida College of Medicine; Norman Fixel Institute for Neurological Diseases (MJA); Department of Biostatistics (YD, BL, ZL), University of Florida College of Medicine, Gainesville; Departments of Neurology (HLP) and Psychiatry (SMM), University of Michigan, Ann Arbor; Departments of Psychiatry and Psychology (JAF) and Neurology (AML, LKF, BFB), Mayo Clinic Rochester, MN; Department of Neurology (CAM), University of Virginia, Charlottesville; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, FL; and Lewy Body Dementia Association (AST), Lilburn, GA
| | - Kaitlin Sovich
- Department of Neurology (MJA, KS), University of Florida College of Medicine; Norman Fixel Institute for Neurological Diseases (MJA); Department of Biostatistics (YD, BL, ZL), University of Florida College of Medicine, Gainesville; Departments of Neurology (HLP) and Psychiatry (SMM), University of Michigan, Ann Arbor; Departments of Psychiatry and Psychology (JAF) and Neurology (AML, LKF, BFB), Mayo Clinic Rochester, MN; Department of Neurology (CAM), University of Virginia, Charlottesville; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, FL; and Lewy Body Dementia Association (AST), Lilburn, GA
| | - Brian LaBarre
- Department of Neurology (MJA, KS), University of Florida College of Medicine; Norman Fixel Institute for Neurological Diseases (MJA); Department of Biostatistics (YD, BL, ZL), University of Florida College of Medicine, Gainesville; Departments of Neurology (HLP) and Psychiatry (SMM), University of Michigan, Ann Arbor; Departments of Psychiatry and Psychology (JAF) and Neurology (AML, LKF, BFB), Mayo Clinic Rochester, MN; Department of Neurology (CAM), University of Virginia, Charlottesville; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, FL; and Lewy Body Dementia Association (AST), Lilburn, GA
| | - Henry L Paulson
- Department of Neurology (MJA, KS), University of Florida College of Medicine; Norman Fixel Institute for Neurological Diseases (MJA); Department of Biostatistics (YD, BL, ZL), University of Florida College of Medicine, Gainesville; Departments of Neurology (HLP) and Psychiatry (SMM), University of Michigan, Ann Arbor; Departments of Psychiatry and Psychology (JAF) and Neurology (AML, LKF, BFB), Mayo Clinic Rochester, MN; Department of Neurology (CAM), University of Virginia, Charlottesville; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, FL; and Lewy Body Dementia Association (AST), Lilburn, GA
| | - Susan M Maixner
- Department of Neurology (MJA, KS), University of Florida College of Medicine; Norman Fixel Institute for Neurological Diseases (MJA); Department of Biostatistics (YD, BL, ZL), University of Florida College of Medicine, Gainesville; Departments of Neurology (HLP) and Psychiatry (SMM), University of Michigan, Ann Arbor; Departments of Psychiatry and Psychology (JAF) and Neurology (AML, LKF, BFB), Mayo Clinic Rochester, MN; Department of Neurology (CAM), University of Virginia, Charlottesville; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, FL; and Lewy Body Dementia Association (AST), Lilburn, GA
| | - Julie A Fields
- Department of Neurology (MJA, KS), University of Florida College of Medicine; Norman Fixel Institute for Neurological Diseases (MJA); Department of Biostatistics (YD, BL, ZL), University of Florida College of Medicine, Gainesville; Departments of Neurology (HLP) and Psychiatry (SMM), University of Michigan, Ann Arbor; Departments of Psychiatry and Psychology (JAF) and Neurology (AML, LKF, BFB), Mayo Clinic Rochester, MN; Department of Neurology (CAM), University of Virginia, Charlottesville; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, FL; and Lewy Body Dementia Association (AST), Lilburn, GA
| | - Angela M Lunde
- Department of Neurology (MJA, KS), University of Florida College of Medicine; Norman Fixel Institute for Neurological Diseases (MJA); Department of Biostatistics (YD, BL, ZL), University of Florida College of Medicine, Gainesville; Departments of Neurology (HLP) and Psychiatry (SMM), University of Michigan, Ann Arbor; Departments of Psychiatry and Psychology (JAF) and Neurology (AML, LKF, BFB), Mayo Clinic Rochester, MN; Department of Neurology (CAM), University of Virginia, Charlottesville; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, FL; and Lewy Body Dementia Association (AST), Lilburn, GA
| | - Leah K Forsberg
- Department of Neurology (MJA, KS), University of Florida College of Medicine; Norman Fixel Institute for Neurological Diseases (MJA); Department of Biostatistics (YD, BL, ZL), University of Florida College of Medicine, Gainesville; Departments of Neurology (HLP) and Psychiatry (SMM), University of Michigan, Ann Arbor; Departments of Psychiatry and Psychology (JAF) and Neurology (AML, LKF, BFB), Mayo Clinic Rochester, MN; Department of Neurology (CAM), University of Virginia, Charlottesville; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, FL; and Lewy Body Dementia Association (AST), Lilburn, GA
| | - Bradley F Boeve
- Department of Neurology (MJA, KS), University of Florida College of Medicine; Norman Fixel Institute for Neurological Diseases (MJA); Department of Biostatistics (YD, BL, ZL), University of Florida College of Medicine, Gainesville; Departments of Neurology (HLP) and Psychiatry (SMM), University of Michigan, Ann Arbor; Departments of Psychiatry and Psychology (JAF) and Neurology (AML, LKF, BFB), Mayo Clinic Rochester, MN; Department of Neurology (CAM), University of Virginia, Charlottesville; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, FL; and Lewy Body Dementia Association (AST), Lilburn, GA
| | - Carol A Manning
- Department of Neurology (MJA, KS), University of Florida College of Medicine; Norman Fixel Institute for Neurological Diseases (MJA); Department of Biostatistics (YD, BL, ZL), University of Florida College of Medicine, Gainesville; Departments of Neurology (HLP) and Psychiatry (SMM), University of Michigan, Ann Arbor; Departments of Psychiatry and Psychology (JAF) and Neurology (AML, LKF, BFB), Mayo Clinic Rochester, MN; Department of Neurology (CAM), University of Virginia, Charlottesville; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, FL; and Lewy Body Dementia Association (AST), Lilburn, GA
| | - James E Galvin
- Department of Neurology (MJA, KS), University of Florida College of Medicine; Norman Fixel Institute for Neurological Diseases (MJA); Department of Biostatistics (YD, BL, ZL), University of Florida College of Medicine, Gainesville; Departments of Neurology (HLP) and Psychiatry (SMM), University of Michigan, Ann Arbor; Departments of Psychiatry and Psychology (JAF) and Neurology (AML, LKF, BFB), Mayo Clinic Rochester, MN; Department of Neurology (CAM), University of Virginia, Charlottesville; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, FL; and Lewy Body Dementia Association (AST), Lilburn, GA
| | - Angela S Taylor
- Department of Neurology (MJA, KS), University of Florida College of Medicine; Norman Fixel Institute for Neurological Diseases (MJA); Department of Biostatistics (YD, BL, ZL), University of Florida College of Medicine, Gainesville; Departments of Neurology (HLP) and Psychiatry (SMM), University of Michigan, Ann Arbor; Departments of Psychiatry and Psychology (JAF) and Neurology (AML, LKF, BFB), Mayo Clinic Rochester, MN; Department of Neurology (CAM), University of Virginia, Charlottesville; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, FL; and Lewy Body Dementia Association (AST), Lilburn, GA
| | - Zhigang Li
- Department of Neurology (MJA, KS), University of Florida College of Medicine; Norman Fixel Institute for Neurological Diseases (MJA); Department of Biostatistics (YD, BL, ZL), University of Florida College of Medicine, Gainesville; Departments of Neurology (HLP) and Psychiatry (SMM), University of Michigan, Ann Arbor; Departments of Psychiatry and Psychology (JAF) and Neurology (AML, LKF, BFB), Mayo Clinic Rochester, MN; Department of Neurology (CAM), University of Virginia, Charlottesville; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, FL; and Lewy Body Dementia Association (AST), Lilburn, GA
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Fleisher JE, Suresh M, Levin ME, Hess SP, Akram F, Dodson D, Tosin M, Stebbins GT, Woo K, Ouyang B, Chodosh J. Learning to PERSEVERE: A pilot study of peer mentor support and caregiver education in Lewy body dementia. Parkinsonism Relat Disord 2023; 113:105492. [PMID: 37385161 PMCID: PMC10527787 DOI: 10.1016/j.parkreldis.2023.105492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/07/2023] [Accepted: 06/16/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Lewy Body Disease (LBD) is the second most common neurodegenerative disorder. Despite high family caregiver strain and adverse patient and caregiver outcomes, few interventions exist for LBD family caregivers. Based on a successful peer mentoring pilot study in advanced Parkinson's Disease, we revised the curriculum of this peer-led educational intervention incorporating LBD caregiver input. OBJECTIVE We assessed feasibility of a peer mentor-led educational intervention and its impact on LBD family caregivers' knowledge, dementia attitudes, and mastery. METHODS Using community-based participatory research, we refined a 16-week peer mentoring intervention and recruited caregivers online through national foundations. Experienced LBD caregiver mentors were trained and matched with newer caregiver mentees with whom they spoke weekly for 16 weeks, supported by the intervention curriculum. We measured intervention fidelity biweekly, program satisfaction, and change in LBD knowledge, dementia attitudes, and caregiving mastery before and after the 16-week intervention. RESULTS Thirty mentor-mentee pairs completed a median of 15 calls (range: 8-19; 424 total calls; median 45 min each). As satisfaction indicators, participants rated 95.3% of calls as useful, and at week 16, all participants indicated they would recommend the intervention to other caregivers. Mentees' knowledge and dementia attitudes improved by 13% (p < 0.05) and 7% (p < 0.001), respectively. Training improved mentors' LBD knowledge by 32% (p < 0.0001) and dementia attitudes by 2.5% (p < 0.001). Neither mentor nor mentee mastery changed significantly (p = 0.36, respectively). CONCLUSIONS This LBD caregiver-designed and -led intervention was feasible, well-received, and effective in improving knowledge and dementia attitudes in both seasoned and newer caregivers. TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT04649164ClinicalTrials.gov Identifier: NCT04649164; December 2, 2020.
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Affiliation(s)
- Jori E Fleisher
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA.
| | - Madhuvanthi Suresh
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Melissa E Levin
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA; Chicago Medical School - Rosalind Franklin University, North Chicago, IL, USA
| | - Serena P Hess
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Faizan Akram
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | | | - Michelle Tosin
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Glenn T Stebbins
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Katheryn Woo
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Bichun Ouyang
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Joshua Chodosh
- Department of Medicine, New York University School of Medicine, New York, NY, USA; Medicine Service, VA New York Harbor Healthcare System, New York, NY, USA
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