NEUROPSYCHOLOGICAL DEFICITS, CAREGIVERS PERCEPTION OF DEFICITS AND CAREGIVER BURDEN

Objective: We tested three hypotheses about the effects of perceived a nd actual patient deficits on caregiver burden: (1) objective patient deficits directly influence caregiver burden; (2) caregiver burden is the result of caregiver perceptions of patient deficits; (3) objective patient deficits influence caregiver burden indirectly by determining perceived deficits. Design: Causal modeling. Setting: A hospital-base d out-patient diagnostic clinic. Participants: An elderly sample (n = 136) referred to a diagnostic dementia clinic and their caregivers. Me asurements: Neuropsychological tests of patient functioning, a measure of patient mood (the Geriatric Depression Scale), caregiver perceptio ns of patient functioning, and a measure of caregiver burden (the Burd en Interview). Results: The Geriatric Depression Scale and neuropsycho logical battery-based indices of functioning were not predictive of ca regiver burden. Caregiver perceptions of patient dysphoria, and of eve ryday functioning skills were related to burden. Caregiver perceptions of patient memory, self-care, and language skills were unrelated to c aregiver burden. Conclusions: The results are consistent with the Laza rus and Folkman model of stress and coping; the caregiver's perception s of the patient's functioning were the most important determinants of caregiver burden. Objective patient deficits influenced caregiver bur den indirectly by influencing caregiver perceptions of patient deficit s. These findings suggest that practitioners attempting to assess and manage caregiver burden should attend to the caregivers' perceptions o f patient mood and everyday functioning. The relationship of caregiver appraisals with actual patient deficits also sheds light on the natur e of caregiver stress.