Summary

Background. The Alzheimer’s disease (AD) is a neurodegenerative disorder which symptoms include memory loss, problems with language, disorientation (including easily getting lost), mood swings, loss of motivation, self-neglect, and behavioral issues. Caregivers of patients with AD often experience distress, reduced quality of life and symptoms of anxiety or depression. This study aims at demonstrating the effects of psychoeducation on caregiver’s well-being and on AD progression.

Methods. A multicenter study was conducted on 200 patients with mild Alzheimer’s disease and 200 caregivers. Patients were given MMSE, Clinical Dementia Rating (CDR), Barthel Index, Neuropsychiatric Inventory while their caregivers had Hamilton rating scales for anxiety and depression (HRSA and HRSD), Five Minute Speech Sample, Family Problems Questionnaire (QPF), Knowledge Interview (KI), Psychological General Well Being Index (PGWBI), SCID II Interview. They were randomized and the experimental group were given psychoeducational sessions once a week for a six month period.

Results. Caregivers in the experimental group showed significant improvement in anxiety and depressive symptoms (as well as self-control). Furthermore they improved in irritability towards patient behavior.

Conclusion. Psychoeducation proves to be efficient in improving caregivers’ mental well-being and their attitude toward patients affected by Alzheimer’s disease.

INTRODUCTION

The Alzheimer’s disease (AD) is a neurodegenerative disorder that usually starts slowly and progressively worsens. It is the cause of 60-70% of cases of dementia. The most common early symptom is difficulty in remembering recent events. As the disease advances, symptoms can include problems with language, disorientation (including easily getting lost), mood swings, loss of motivation, self-neglect, and behavioral issues 1,2. Caregivers often experience psychological burden, especially in reaction to health degeneration, increased assistance and behavioral issues 3-5. Pharmacological options are fundamental in slowing down AD advancements, but non-pharmacological interventions are among treatment options for those patients with the goal of improving their quality of life as well as the possibility of taking care 6. Caregivers may need support to face difficulties associated with daily management of patients with AD. Specific support for caregivers can improve their own quality of life and improve adjustment symptoms like anxiety or irritability 7-9. Psychoeducation for caregivers is among the possibilities they can take advantage of to dwell with difficulties and understand AD characteristics, evolution and how to be helpful and supportive 10-16.

METHODS

Sample

A total sample of 200 patients with AD and their respective 200 caregivers were recruited on a voluntary basis from different hospitals:”Villa Maria Luigia”Casa di Cura (Monticelli Terme-PR), Psychiatric Outpatient Department (Palermo), ARS-Association for Research on Schizophrenia (Milan).

Inclusion/exclusion criteria

Patients’ inclusion criteria

Satisfaction of ICD-10 criteria (WHO 1991) for AD, onset in the last 36 months (mild Alzheimer), Outpatient treatment, TC/RMN compatible with the diagnosis of AD (absence of focal lesions), no visual or hearing impairment.

Patients’ Exclusion Criteria

Moderate or serious AD, Admission to Hospital, Major Depressive Episode, Delirium, unstable Thyroid disorders, Vitamin B12 or Folate Deficits, History of alcohol or drug abuse.

Caregivers inclusion criteria

To be primary caregivers (spouse, offspring, relatives or friends that primarily take care of the patient), Mini Mental State Examination (MMSE) score > 15, only one for each patient

Caregivers Exclusion Criteria

Acute psychopathology, MMSE score ≤ 15

TEST

 

Patients

History, blood test, MMSE, Clinical Dementia Rating (CDR), Barthel Index, Neuropsychiatric Inventory.

Caregivers

History and involvement in patient treatment, MMSE, Hamilton Rating Scale for Anxiety (HRSA) and Hamilton Rating Scale for Depression (HRSD), Five Minute Speech Sample, Family Problems Questionnaire (QPF), Knowledge Interview (KI), Psychological General Well Being Index (PGWBI), SCID II Interview.

Study design

The sample was randomized in two groups: 50% of the caregivers represented the experimental group (GrEXP) and the other 50% the control group (GrCTRL).

GrEXP were given psychoeducational sessions once a week, for a six-month-period and GrCTRL were not given any kind of psychoeducation or psychotherapy.

Statistics

Data were analyzed using SPSS 27 using Pearson chi-square for non-continuous variables and T test/T test for repeated measures for continuous variables. All the tests were two-tailed, and statistical significance threshold was set at p < 0.05.

Ethics

Informed consent of the participants was obtained after the nature of the procedures was fully explained. None of the participants received compensation for their contribution. The investigation was carried out in accordance with the latest version of the Declaration of Helsinki. The study was authorized and approved by each hospital ethical Committee.

RESULTS

Sample characteristics (Tab. I)

Caregivers were mostly female offspring of the patients in both the groups. Caregivers from GrEXP and GrCTRL were not statistically different at T0 in personal characteristics (age, gender, education, work position, assistance to the patient) and test results. The proportion of caregivers who live with the patient is higher in GrEXP as well as the number of those who assist the patients at night. GrEXP had MMSE at T0 = 29.01 ± 1.63 while GrCTRL at T0 was 28.69 ± 2.26 (p = .32). SCID II showed 2 (3.12%) cluster A, 7 (10.93%) cluster B, 36 (56.25%) cluster C and 8 (12.5%) NAS in GrEXP vs 5 (7.04%) cluster A, 3 (4.22%) cluster B, 39 (54.92%) cluster C and 3 (4.22%) NAS in GrCTRL (χ2 = .20, .26, .45 and .16 respectively).

Patients had no significant difference in their characteristics or tests at T0 (Tab. II).

Once attested a significance in the difference of the length of time since AD onset, we made an in-depth analysis to evaluate if a patient’s condition might have influenced caregivers’ wellbeing. The grade of patient disability did not influence caregivers’ level of depression or anxiety in both the groups.

Caregivers’ test at T1

Caregivers’ test scores at T1 (six-month-period) showed a significant improvement in GrEXP for HRSA, HRSD and PGWBI self-control, while none of the tests improved in GrCTRL (Tab. III).

We selected some items of KI, especially linked to acceptance of a patient’s illness or embarrassment/irritability for his/her behavior. A pessimistic vision caregivers may have about a patient’s future (item 13) or a reaction of refusal toward the patient’s illness (item 14) did not statistically change between T0 and T1 both for GrEXP and GrCTRL. We report results of 4 items of QPF (62, 63, 65, 82): often/always criticize patients for his/her behavior, feel embarrassed for patient’s behavior, feel irritated for patient’s behavior and cannot stand the situation any further. Irritability toward patient’s behavior significantly improved in Gr EXP while the other items did not have significant modifications in both the groups (Tab. III).

DISCUSSION

The aim of this study was to attest the role of psychoeducation about AD and if it might help caregivers in terms of personal mental wellbeing and in the way they react to and support AD patients.

The groups of patients did not differ clinically or in tests administered. The only difference we identified was in the time from AD onset, but we proved that patients’ condition did not influence caregivers mental health at T0.

Caregivers who were given psychoeducational sessions demonstrated an improvement in their anxiety and depressive levels. Moreover, they showed a slightly greater, but significant, self-control and lower irritation toward the patient’s behavior.

In conclusion, psychoeducation proved to be efficient in improving caregivers’ mental wellbeing and their attitude towards the illness. The spread of neurodegenerative diseases, including AD, along with the effectiveness demonstrated by psychoeducation might suggest and highlight the importance of systematically providing psychoeducation to primary caregivers of patients affected by neurodegenerative diseases in order to support them and prevent secondary mental illness and burnout.

Funding

Conflict of interest statement

The authors declare no conflict of interest.

Figures and tables

Caregivers Patients
GrEXP (n=96) GrCTRL (n=89) GrEXP (n=96) GrCTRL (n=89)
Age 52.84 (10.63) 51.66 (12.91) Age 76,8 ± 7,8 76,4± 8,7
Gender female 67 (71.28%) 62 (73.81%) Gender female 70 (72,92%) 57 (67,06%)
Relation: Spouse (%)Son/daughter (%)Relative/friend/other (%) 28 (30.11%)57 (61.29%)8 (8.60%) 18 (21.18%)57 (73.81%)10 (11.76%) Marital status: not married (%)married (%)widow/divorced (%) 5 (6,17%)40 (49,38%)36 (44,44%) 8 (10,81%)26 (35,14%)40 (54,05%)
Education: yearsprimary (%)secondary (%) 10.7443 (52.44%)39 (47.56%) 10.5940 (48.19%)43 (51.81%) Offspring: no (%)one (%)two or more (%) 1 (1,49%)7 (10,45%)59 (88,06%) 0 (0%)22 (38,60%)35 (61,40%)
Work: Blue collar (%)White collar (%)Other (%) 26 (32.10%)33 (40.74%)22 (27.16%) 22 (26.51%)44 (53.01%)17 (20.48%) Education: yearsprimary (%)secondary (%) 6,7626 (32,10%)55 (67,90%) 5,9723 (31,51%)50 (68,49%)
Kind of assistance: live with patient (%)Assistance (%) 43 (51.19%)41 (48.81%) 30 (39.47%)46 (60.53%) Work: Blue collar (%)White collar (%)Other (%) 54 (65,85%)16 (19,51%)12 (14,63%) 39 (52,70%)19 (25,68%)16 (21,62%)
Daily duty 9.8 ±8.00 8.9 ±7.44 Live with: alone (%)family(%)professional assistance (%) 9 (10,98%)70 (85,37%)3 (3,66%) 15 (20,27%)46 (62,16%)13 (17,57%)
Night assistance: 16 (76.19%) 8 (61.54%) Alcohol: 29 (29,27%) 19 (25,68%)
Tobacco 8 (9,76%) 5 (6,76%)
AD Family history 28 (34.57%) 28 (37.84%)
Psychiatric Family history 9 (11.11%) 6 (8.00%)
AD onset: (months) 37.14 ±2.34) 33.88 ±2.73)
Laboratory tests: pathological (%) 10 (12.20%) 6 (8.22%)
TABLE I. Patients and caregivers’ characteristics.
GrEXP(n=96) GrCTRL(n=89) p/χ2
MMSE 18,16 ± 4,10 17,82 ± 4,16 .58
Barthel Index: 86,15 ± 16,74 84,69 ± 14,17 .52
CDR: 81 (95,29%) 73 (94,81%) .69
NPI total 24,30 ± 16,68 22,93 ± 17,74 .59
TABLE II. Patients test results at T0.

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Authors

Ester di Giacomo - Psychiatric Department-IRCCS San Gerardo di Monza Foundation, Monza, Italy; School of Medicine and Surgery, University of Milan Bicocca, Milano, Italy

Fabrizia Colmegna - Psychiatric Department-IRCCS San Gerardo di Monza Foundation, Monza, Italy

Marco de Berardis - Casa di Cura “Villa Maria Luigia”, Monticelli Terme, Italy

Attilio Negri - School of Medicine and Surgery, University of Milan Bicocca, Milano, Italy

Salvatore Varia - Centro Salute Mentale N.5, ASL 6, Palermo, Italy

Massimo Clerici -  Psychiatric Department-IRCCS San Gerardo di Monza Foundation, Monza, Italy; School of Medicine and Surgery, University of Milan Bicocca, Milano, Italy

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Copyright (c) 2025 Italian Journal of Psychiatry

How to Cite
di Giacomo, E., Colmegna, F., de Berardis, M., Negri, A., Varia, S., & Clerici, M. (2025). Psychoeducation for caregivers of patients with Alzheimer’s Disease: efficacy and impact on illness progression. Italian Journal of Psychiatry, 11(3). https://doi.org/10.36180/2421-4469-2025-1145
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