Toward enhanced understanding and rigor: addressing limitations in studying dementia symptoms and caregiver interventionsDear Editor,
The article entitled “Behavioral and Psychological Symptoms of Dementia in Long-Term Care Setting: Assessment of Elderly Adults and Intervention for Caregivers,” by Duarte et al.1, published in Dementia and Neuropsychologia on November 27, 2023, significantly contributes to the literature on the psychological symptoms of dementia in long-term care settings. However, given the future rise in the prevalence of dementia in the growing elderly population, certain limitations, methodological challenges, and inquiries regarding the qualitative approach of such studies deserve attention to provide more robust evidence regarding the effectiveness of these interventions.
Firstly, no distinction is made for confounding factors for the parameters analyzed in the article, such as mentioning the genders of dementia patients. In this regard, it would be important for the authors to adequately report confounding variables that may influence results, such as participants’ demographic characteristics, comorbidities, and other factors that may interfere with the outcomes2,3.
Secondly, considering that the addressed patients belong to diverse cultural and social contexts, the study fails to implement a randomized controlled trial design, where participants are randomly assigned to an intervention group and a control group. This would help minimize selection bias and establish stronger causal relationships4,5.
Thirdly, to better assess intervention efficacy, it would be beneficial to conduct long-term follow-ups to determine whether observed positive effects are sustained over time or if there are long-term changes in caregivers’ and patients’ well-being6,7.
Fourthly, there is no standardization in the psychoeducational intervention, including content, duration, frequency, and methodology. A rigorous standardization of the intervention would help ensure consistency in delivery and implementation.
In conclusion, acknowledging the valuable contribution of the study amid an alarming future, addressing the aforementioned limitations, will strengthen its internal and external validity, reliability, and relevance of the obtained results. This will enhance the study’s rigor and facilitate a more nuanced understanding of the implications of psychological symptoms of dementia in long-term care settings within the scientific community, enabling a more widespread implementation of caregiver qualification and training interventions for dementia patients.
-
This study was conducted by the Group Brazilian league of neurology and neurosurgery, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil.
-
Funding:
none.
REFERENCES
-
1 Duarte ESR, Jacinto AF. Behavioral and psychological symptoms of dementia in the long-term care setting: assessment of aged adults and intervention for caregivers. Dement Neuropsychol. 2023;17:e20230018. https://doi.org/10.1590/1980-5764-DN-2023-0018
» https://doi.org/10.1590/1980-5764-DN-2023-0018 -
2 Kuroda Y, Sugimoto T, Satoh K, Suemoto CK, Matsumoto N, Uchida K, et al. Factors associated with behavioral and psychological symptoms of dementia during COVID-19. Int J Environ Res Public Health. 2022;19(16):10094. https://doi.org/10.3390/ijerph191610094
» https://doi.org/10.3390/ijerph191610094 -
3 Avondino E, Antoine P. Heterogeneity of cognitive anosognosia and its variation with the severity of dementia in patients with Alzheimer’s disease. J Alzheimers Dis. 2016;50(1):89-99. https://doi.org/10.3233/JAD-150496
» https://doi.org/10.3233/JAD-150496 -
4 Pedraza O, Lucas JA, Smith GE, Petersen RC, Graff-Radford NR, Ivnik RJ. Robust and expanded norms for the Dementia Rating Scale. Arch Clin Neuropsychol. 2010;25(5):347-58. https://doi.org/10.1093/arclin/acq030
» https://doi.org/10.1093/arclin/acq030 -
5 Sefcik JS, Boltz M, Dellapina M, Gitlin LN. Are interventions for formal caregivers effective for improving dementia care? A systematic review of systematic reviews. Innov Aging. 2022;6(2):igac005. https://doi.org/10.1093/geroni/igac005
» https://doi.org/10.1093/geroni/igac005 -
6 Signe A, Elmståhl S. Psychosocial intervention for family caregivers of people with dementia reduces caregiver’s burden: development and effect after 6 and 12 months. Scand J Caring Sci. 2008;22(1):98-109. https://doi.org/10.1111/j.1471-6712.2007.00498.x
» https://doi.org/10.1111/j.1471-6712.2007.00498.x -
7 Farran CJ, Gilley DW, McCann JJ, Bienias JL, Lindeman DA, Evans DA. Efficacy of behavioral interventions for dementia caregivers. West J Nurs Res. 2007;29(8):944-60. https://doi.org/10.1177/0193945907303084
» https://doi.org/10.1177/0193945907303084
