Neuropsychiatric symptoms of dementia and caregiver burden: a systematic review and meta-regression

Managing neuropsychiatric symptoms is crucial in dementia. The Neuropsychiatric Inventory-Distress (NPI-D) assesses caregiver distress, and the Zarit Burden Interview (ZBI) evaluates overall burden. Objective: This meta-regression examined the relationship between ZBI and NPI-D with NPI total scores to explore how burden relates to caregiver distress and neuropsychiatric symptoms. Methods: After a systematic review of studies addressing neuropsychiatric symptoms and caregivers' burden in people with dementia, a meta-regression was conducted to examine the association between NPI-D and ZBI scores and NPI total scores. We used data from five studies reporting NPI-D scores and seven reporting ZBI scores. Single-arm meta-analyses for NPI-D, NPI total, and ZBI scores were performed using a random-effects model. Results: The random-effects model estimated a mean ZBI score of 23.76 [95% confidence interval - 95%CI 14.32-33.20, I2=100%, p=0]. NPI-D scores had a mean of 10.09 [95%CI 6.56-13.63, I2=96%, p<0.01], and the mean NPI total score was 21.84 [95%CI 19.31-24.38, I2=95%, p<0.01]. The meta-regression between NPI-D Mean and NPI total scores showed a statistically significant relationship, with a coefficient of 1.32 [95%CI 0.97-1.68, p=0.000], indicating a strong association between caregiver distress and neuropsychiatric symptoms. Conclusion: Single-arm studies suggest a positive relationship between neuropsychiatric symptoms and caregiver burden. The meta-regression analysis between NPI-D and NPI total demonstrates a significant link between caregiver distress and neuropsychiatric symptoms. Future studies should develop precise tools capturing caregivers' challenges and burden. PROSPERO: CRD42024567953.