31 Caregivers generally report experiencing some form of strain, including all the 85 caregivers in the Sanders (2005) study.17,33 Psychological morbidity Strain can manifest as psychological morbidity, including depression and anxiety. A robust relationship between dementia caregiving and negative effects on psychological health has been demonstrated in numerous studies.31,34,35 Rates of depression vary between 23% and 85% in developed countries,33,36 and of anxiety between 16% and 45%. 34,37-39 In the developing countries psychiatric morbidity range from 40% to 75%.10 Levels of psychological distress and

stress Inhibitors,research,lifescience,medical are significantly higher, and levels of self-efficacy, subjective wellbeing, and physical health significantly lower, in dementia caregivers than in other caregivers; these differences are even larger when compared with noncaregivers. 40 Many factors may moderate the presence

of symptoms: being female, being a spousal caregiver, Inhibitors,research,lifescience,medical additional stressful life events, physical health, family history of mental health issues, quality of relationship between caregiver and care receiver, life satisfaction, low levels of self esteem and mastery, high Inhibitors,research,lifescience,medical neuroticism, and levels of behavioral and psychological symptoms of BPSD.31,39,41 (Table I). Table I. Pridictors of and protectors from caregiver distress. FTD, frontotemporal dementia; BPSD, behavioral and psychological problems in dementia Inhibitors,research,lifescience,medical Physical morbidity Dementia caregivers are at an increased risk of various health problems including cardiovascular problems, lower immunity, poorer immune response to vaccine, slower wound healing, higher levels of chronic conditions (such as diabetes, arthritis,

ulcers, and anemia), more doctor visits and use of prescription medications, poorer selfrated health, decreased engagement in preventative health behaviors such as exercise, and greater likelihood Inhibitors,research,lifescience,medical of smoking, drinking alcohol, and poor sleep patterns.5,7,42,72-78 Caregivers report a greater number of physical health problems and worse overall health compared with noncaregiver controls.28,42 Those with psychological morbidity and greater strain are even more likely to have poor physical health and a higher risk of mortality.41,79 Social isolation Caregivers often lack social contact and support and experience feelings of social isolation: 41-80 Caregivers tend to sacrifice their leisure pursuits and hobbies, to restrict time with friends and family, because and to give up or reduce employment.“41,81 Caregivers who are more satisfied with their social interactions show fewer negative psychological symptoms.53 Interventions may assist. One psychosocial intervention significantly increased the number of support persons for caregivers, their GSK J4 in vitro satisfaction with their support network, and the assistance they received with caregiving, compared with controls.82 Financial Costs of dementia are high.