Overall and domain-specific neuropsychiatric symptoms in relation to caregiver burden among family caregivers of individuals with cognitive impairment
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University , ,
- 2School of Nursing, Capital Medical University , ,
Abstract
Background: Neuropsychiatric symptoms (NPS) are common across the continuum of cognitive impairment and represent a major source of distress for family caregivers. Because NPS often co-occur in real-world care settings, it remains clinically important to determine whether caregiver burden is more closely related to cumulative NPS burden or to specific symptom domains.
Objective: This study aimed to describe the prevalence and distribution of NPS and to examine the associations of Neuropsychiatric Inventory (NPI) total score, symptom count, caregiver-distress total score, and individual NPI domain scores with caregiver burden among Chinese patient-caregiver dyads with cognitive impairment.
Methods: This single-center cross-sectional study included 418 patient–caregiver dyads recruited from the Neurodegenerative and Cognitive Disorders inpatient unit of Xuanwu Hospital, Capital Medical University. NPS were assessed using the NPI and caregiver burden using the ZBI. Associations between global and domain-level NPI measures and ZBI total score were examined using Spearman correlations and multivariable linear regression adjusted for patient clinical characteristics, cognitive and functional status, and caregiver-related factors. Domain-level P values were corrected using the Benjamini–Hochberg false discovery rate. Additional analyses separately modeled the 12 domain-specific frequency and severity ratings and examined within-domain frequency-by-severity interactions. Multiple imputation and sensitivity analyses were used to assess robustness.
Results: At least one NPS was present in 251 patients (60.0%; 95% CI, 55.3%–64.6%). The most common symptoms were apathy/indifference (30.4%), depression/dysphoria (25.1%), anxiety (23.0%), nighttime behaviors (21.1%), and irritability/lability (18.7%). Among the 403 dyads with complete observed ZBI data, ZBI total score was correlated with NPI total score (Spearman ρ = 0.308), symptom count (ρ = 0.313), and caregiver-distress total score (ρ = 0.336; all P < 0.001). In the multiple-imputation analysis including all 418 dyads, higher NPI total score remained associated with higher ZBI total score after multivariable adjustment (B = 0.357; 95% CI, 0.236–0.478; standardized β = 0.339; P < 0.001), with similar associations for symptom count and caregiver-distress total score. No individual NPI domain remained significant after simultaneous adjustment and FDR correction. In co-occurrence analyses, the number of other positive NPI domains was consistently associated with higher ZBI scores. In the domain-level frequency, severity, and within-domain interaction analyses, no association remained significant after FDR correction. Sensitivity analyses were consistent with the primary findings.
Conclusion: NPS were common among individuals with cognitive impairment and were associated with greater caregiver burden. Cumulative NPS measures showed more consistent associations with caregiver burden than individual symptom domains. These findings support comprehensive assessment of overall neuropsychiatric symptom burden when evaluating family caregiver burden.
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BibTeX
@article{yang2026overall,
title = {{Overall and domain-specific neuropsychiatric symptoms in relation to caregiver burden among family caregivers of individuals with cognitive impairment}},
author = {Xuan Yang and Jinli Wang and Na Wei and Kaiting Fan and Hong Chen and Yuchen Qiao},
journal = {Frontiers in psychiatry},
year = {2026},
month = sep,
doi = {10.3389/fpsyt.2026.1937017},
url = {https://europepmc.org/article/PMC/PMC13664287},
note = {CC BY},
}
RIS
TY - JOUR
TI - Overall and domain-specific neuropsychiatric symptoms in relation to caregiver burden among family caregivers of individuals with cognitive impairment
AU - Xuan Yang
AU - Jinli Wang
AU - Na Wei
AU - Kaiting Fan
AU - Hong Chen
AU - Yuchen Qiao
PY - 2026
DA - 2026/09/30
JO - Frontiers in psychiatry
DO - 10.3389/fpsyt.2026.1937017
UR - https://europepmc.org/article/PMC/PMC13664287
AB - Background: Neuropsychiatric symptoms (NPS) are common across the continuum of cognitive impairment and represent a major source of distress for family caregivers. Because NPS often co-occur in real-world care settings, it remains clinically important to determine whether caregiver burden is more closely related to cumulative NPS burden or to specific symptom domains. Objective: This study aimed to describe the prevalence and distribution of NPS and to examine the associations of Neuropsychiatric Inventory (NPI) total score, symptom count, caregiver-distress total score, and individual NPI domain scores with caregiver burden among Chinese patient-caregiver dyads with cognitive impairment. Methods: This single-center cross-sectional study included 418 patient–caregiver dyads recruited from the Neurodegenerative and Cognitive Disorders inpatient unit of Xuanwu Hospital, Capital Medical University. NPS were assessed using the NPI and caregiver burden using the ZBI. Associations between global and domain-level NPI measures and ZBI total score were examined using Spearman correlations and multivariable linear regression adjusted for patient clinical characteristics, cognitive and functional status, and caregiver-related factors. Domain-level P values were corrected using the Benjamini–Hochberg false discovery rate. Additional analyses separately modeled the 12 domain-specific frequency and severity ratings and examined within-domain frequency-by-severity interactions. Multiple imputation and sensitivity analyses were used to assess robustness. Results: At least one NPS was present in 251 patients (60.0%; 95% CI, 55.3%–64.6%). The most common symptoms were apathy/indifference (30.4%), depression/dysphoria (25.1%), anxiety (23.0%), nighttime behaviors (21.1%), and irritability/lability (18.7%). Among the 403 dyads with complete observed ZBI data, ZBI total score was correlated with NPI total score (Spearman ρ = 0.308), symptom count (ρ = 0.313), and caregiver-distress total score (ρ = 0.336; all P < 0.001). In the multiple-imputation analysis including all 418 dyads, higher NPI total score remained associated with higher ZBI total score after multivariable adjustment (B = 0.357; 95% CI, 0.236–0.478; standardized β = 0.339; P < 0.001), with similar associations for symptom count and caregiver-distress total score. No individual NPI domain remained significant after simultaneous adjustment and FDR correction. In co-occurrence analyses, the number of other positive NPI domains was consistently associated with higher ZBI scores. In the domain-level frequency, severity, and within-domain interaction analyses, no association remained significant after FDR correction. Sensitivity analyses were consistent with the primary findings. Conclusion: NPS were common among individuals with cognitive impairment and were associated with greater caregiver burden. Cumulative NPS measures showed more consistent associations with caregiver burden than individual symptom domains. These findings support comprehensive assessment of overall neuropsychiatric symptom burden when evaluating family caregiver burden.
SN - 1664-0640
ER -