Caregiver-Care Recipient Relationship Closeness is Associated With Neuropsychiatric Symptoms in Dementia

Elizabeth K. Vernon, Bryce Cooley, William Rozum, Gail B. Rattinger, Stephanie Behrens, Joshua Matyi, Elizabeth Fauth, Constantine G. Lyketsos, Jo Ann T. Tschanz

Research output: Contribution to journalArticlepeer-review


Objective: Closer caregiver-care recipient (CG-CR) relationships are associated with better cognitive and functional abilities, activities of daily living (in persons with dementia), and lower informal care costs. Methods: Due to the difficulty in treating neuropsychiatric symptoms (NPSs) and their detrimental effects on caregivers and care recipients, we examined whether closeness of CG-CR relationships was associated with overall NPS severity or with specific NPS symptom domains in care recipients. In a longitudinal population-based study in Cache County, Utah, the 12-item Neuropsychiatric Inventory (NPI-12) was assessed in 300 CG-CR dyads. Caregivers reported current relationship closeness using the Whitlatch Relationship Closeness Scale. Linear mixed models examined associations between CG-CR closeness and NPI-12 total score or selected symptom domains over time (observation period: 2002–2012). Results: In unadjusted linear mixed models, higher closeness scores were associated with a five-point lower NPI-12 score and a one-point lesser increase in NPI-12 per year. NPI scores also showed lower affective cluster scores (two points) and lesser increase in psychosis cluster (approximately 0.5 points per year) and agitation/aggression (0.16 points per year) for each unit increase in closeness. When controlling for NPI caregiver distress, associations between closeness and NPSs diminished to a 0.5-point lesser increase in total NPI-12 score per year. Adjusted models for NPI domains/clusters showed −0.32 points per year for the psychosis cluster, −0.11 points per year for agitation/aggression, and −0.67 overall for the affective cluster. Conclusion: Higher CG-CR closeness, a potentially modifiable factor, is associated with lower NPS severity and may provide a target for intervention.

Original languageEnglish (US)
Pages (from-to)349-359
Number of pages11
JournalAmerican Journal of Geriatric Psychiatry
Issue number4
StatePublished - Apr 2019


  • Alzheimer disease
  • Dementia
  • caregiver and care recipient
  • neuropsychiatric symptoms
  • relationship closeness

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Psychiatry and Mental health


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