Symptom-Specific Associations Between Behavioral and Psychological Symptoms of Dementia and Caregiver Depression: A Network Analysis

AI Summary

Global BPSD were primarily associated with caregivers' sense of failure and fatigue, with a smaller association with depressed mood.
Most BPSD domains did not show unique associations, suggesting shared mechanisms linking care-recipient symptoms to caregiver depressive symptoms.
Domain-specific links emerged: aggressiveness uniquely associated with sense of failure and depressed mood, diurnal rhythm and activity disturbances linked to fatigue.

Am J Geriatr Psychiatry. 2026 Apr 19:S1064-7481(26)00364-7. doi: 10.1016/j.jagp.2026.04.007. Online ahead of print.

ABSTRACT

OBJECTIVE: Behavioral and psychological symptoms of dementia (BPSD) are a major risk factor for depressive symptoms in family caregivers of people with dementia, yet the mechanisms linking BPSD to caregiver depression remain insufficiently understood. This study adopted a symptom-specific perspective to examine associations between BPSD and individual depressive symptoms in caregivers.

METHODS: We analyzed an integrative cross-sectional dataset from three randomized controlled trials including family caregivers of people with dementia (N = 440). Associations between global and domain-specific BPSD (BEHAVE-AD) and caregivers’ depressive symptoms (CES-D) were examined using regularized Gaussian graphical network models.

RESULTS: Global BPSD were primarily linked to caregivers’ sense of failure and fatigue, with a smaller association with depressed mood. When individual BPSD domains were considered simultaneously, most domains did not show unique associations with depressive symptoms, suggesting that associations between BPSD and caregiver depressive symptoms are partly shared across domains. Nevertheless, some domain-specific associations were observed: aggressiveness was uniquely associated with sense of failure and depressed mood, whereas diurnal rhythm disturbances and activity disturbances showed specific associations with fatigue.

CONCLUSIONS: These findings provide initial evidence for symptom-level associations between BPSD and caregiver depressive symptoms, particularly involving sense of failure and fatigue. They further suggest that different BPSD domains may show somewhat different patterns of association with these depressive symptoms. A symptom-specific perspective may contribute to a more nuanced understanding of how care-recipient symptoms relate to caregiver mental health and may help inform more targeted intervention approaches.

PMID:42135156 | DOI:10.1016/j.jagp.2026.04.007

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