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Burden and well-being among dementia caregivers in Puerto Rico: the role of behavioral and psychological symptoms of dementia

Year: 2026

Type: article

Abstract: OBJECTIVES: Dementia is more prevalent in Puerto Rico than in the U.S. mainland, increasing demands for caregiving. However, research on the mental health impact of dementia caregiving among island Puerto Ricans is sparse. We examined caregiver burden and depressive symptoms among Puerto Rican dementia caregivers while also considering behavioral and psychological symptoms of dementia (BPSD). METHODS: Using data from the Puerto Rican Elder: Health Conditions (PREHCO) study (Wave 3), 132 caregivers of PREHCO participants requiring care completed an ancillary data collection, of whom 101 cared for PREHCO participants with dementia. Measures included the 15-item Geriatric Depression Scale (depressive symptoms), Neuropsychiatric Inventory Questionnaire (NPI-Q; BPSD), and Zarit Burden Interview (ZBI-6; caregiver burden). RESULTS: Caregivers were 63 ± 10 years of age on average, and 77% were women. Exploratory factor analysis yielded two BPSD factors: Emotional Dysfunction/Behavioral Instability and Perceptual Disturbances/Apathy. In linear regression models adjusted for age, sex, education, marital status, self-rated health, hours of caregiving per week, and perceived social support, caregiver burden was positively associated with depressive symptoms (β = 0.68, p < .001), as were BPSD factors Emotional Dysfunction/Behavioral Instability (β = 0.50, p < .001) and Perceptual Disturbances/Apathy (β = 0.50, p < .001). Only Perceptual Disturbances/Apathy significantly moderated this association (β = 0.24, p = .032), with the burden-depression link strengthening as BPSD increased. Appetite/Eating Symptoms (β = 0.42, p = .007) emerged as the main BPSD item driving this moderation effect. DISCUSSION: In this Puerto Rico-based sample, perceptual disturbances/apathy, and appetite/eating symptoms specifically, were most likely to magnify the caregiver burden-depressive symptoms link.

Source: The Journals of Gerontology Series B

DOI: 10.1093/geronb/gbag014