Weizhou Tang

Date of Award

Summer 2019

Document Type

Open Access Dissertation


College of Social Work

First Advisor

Sue E. Levkoff


Alzheimer’s disease (AD) is the most common neurodegenerative disease and is a leading cause of dementia. Behavioral and psychological symptoms (BPS) represent a heterogeneous group of non-cognitive symptoms and behaviors occurring in persons with Alzheimer’s disease (PwAD), and they are often associated with negative outcomes for AD caregivers. Evidence indicates differences in caregivers’ mental health across race/ethnic groups. However, there is a lack of research that compares racial differences in the association between BPS in PwAD and caregiver depression. The aims of this dissertation, which are grounded in the Stress Process Model, include: 1) To compare racial differences in BPS in PwAD both as disparate symptoms and as symptoms that co-occur together; 2) To assess how BPS in PwAD impact depressive symptoms in caregivers of PwAD; and 3) To assess whether the impact of BPS on caregiver depressive symptoms differs across race.

The data used in the study were from the South Carolina Alzheimer’s Disease Registry, which included PwAD who were eligible for a Medicaid waiver program and their unpaid informal caregivers. The final sample for this study included 635 dyads, with 313 African Americans and 322 whites. Four clusters of PwAD were identified including Cluster 1: Minimally Symptomatic; Cluster 2: Apathetic; Cluster 3: Psychotic & Hyperactive; and Cluster 4: Highly Symptomatic. White PwAD exhibited more severe symptoms than African Americans, and white caregivers reported a higher level of depressive symptoms than African Americans. Both caregiver level of burden and distress mediated the relationship between BPS in PwAD and caregiver level of depressive symptoms. However, there were no racial differences in the relationship between BPS in PwAD and caregiver level of depressive symptoms.

The findings of this study highlight the importance of developing more effective and targeted treatment options and therapies for neuropsychiatric symptoms and delivering cultural relevant education programs/interventions to ethnic groups. Future studies can benefit from profiling PwAD over the course of the disease and examining the longitudinal effects of BPS in PwAD on caregiver depression.


© 2019, Weizhou Tang

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