Are advanced dementia staging and severity of neuropsychiatric behavioral symptoms associated with the likelihood of divorce or separation in older adulthood? YaleSPH YaleMed Yale dementia neuropsychiatric symptoms divorce elderley adulthood
By Tarun Sai LomteMar 2 2023Reviewed by Danielle Ellis, B.Sc. *Important notice: Preprints with The Lancet publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.
Meanwhile, the prevalence of dementia has also increased among older adults, with evidence suggesting a strain on close relationships. Research has demonstrated the negative impact of dementia caregiving on spouses. Still, it remains unknown whether neuropsychiatric behavioral symptoms and dementia staging are associated with divorce/separation for older couples.
Necessary information for the clinical dementia rating was obtained through semi-structured interviews with the patient, reliable informants, or a family source. The primary exposure was 12 symptoms from the Neuro-Psychiatric Inventory – anxiety, agitation/aggression, appetite, apathy/indifference, depression/dysphoria, delusions, motor disturbance, hallucinations, euphoria/elation, nighttime behaviors, disinhibition, and irritability.
Nearly 19% of cases and 6.4% of controls had child informants. Informant reports were obtained before divorce/separation. Cases were less likely to live with informants than controls. Dementia staging measured by CDR score revealed that 53% of cases and 48.5% of controls had no functional impairment.
Intriguingly, when CDR and NPI scores were considered in the model, the association between dementia staging and divorce/separation was significant. Specifically, the earlier stage of dementia, but not the later stage, was associated with divorce/separation. In addition, significant associations were evident for the severity of NPI symptoms - aggression, depression, and disinhibition with divorce/separation.
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