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Joe E, Segal-Gidan F, Cummings JL, Galasko D, Tomaszewski Farias S, Johnson DK, Ross L, Yaffe K, Wang X, Schneider LS, Chui H, Ringman JM. Association Between Self- and Proxy-Reported Depression and Quality of Life in Mild-Moderate Alzheimer's Disease. Am J Geriatr Psychiatry 2024; 32:58-67. [PMID: 37827916 PMCID: PMC10843510 DOI: 10.1016/j.jagp.2023.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE Prior studies have reported an association between depression and quality of life (QOL) in Alzheimer's disease (AD), but the effect of self- versus proxy rating of mood and QOL has not been described. DESIGN In this secondary analysis of data from a cohort study, the authors used a linear mixed-effects model to determine if the association between depression and QOL is affected by whether both measures are assessed by the same member of the patient-caregiver dyad. SETTING Participants and caregiver informants were recruited from 10 California Alzheimer Disease Centers. PARTICIPANTS A total of 137 participants with mild-to-moderate Alzheimer's disease and their caregivers. MEASUREMENTS Self- and proxy-rated scores on both the Geriatric Depression Scale (GDS) and the Quality of Life in Alzheimer's Disease scale (QoL-AD). Multivariable linear mixed-effects models were used to estimate the association between depression and QOL. RESULTS Results of the multivariable linear mixed-effects models showed a significant association between self-rated QoL-AD and self-rated (B = -0.49, p <0.0001) but not proxy-rated GDS (B = -0.07, p = 0.19) after adjusting for confounders. Likewise, there was a significant association between proxy-rated QoL-AD and proxy-rated GDS (B = -0.48, p <0.0001) but not self-rated GDS (B = 0.05, p = 0.36). CONCLUSION Depression was associated with QOL in AD over short-term longitudinal follow-up, but the association was not statistically significant if both instruments are not administered to the same member of the patient-caregiver dyad. The choice of self- versus proxy-reported QOL should be intentionally considered in future studies as it may influence reported outcomes.
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Affiliation(s)
- Elizabeth Joe
- Department of Neurology, Keck School of Medicine (EJ, FS-G, XW, LSS, HC, JMR), University of Southern California, Los Angeles, CA.
| | - Freddi Segal-Gidan
- Department of Neurology, Keck School of Medicine (EJ, FS-G, XW, LSS, HC, JMR), University of Southern California, Los Angeles, CA
| | - Jeffrey L Cummings
- Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas, Las Vegas, NV
| | | | | | - David K Johnson
- UC Davis Alzheimer's Disease Research Center-East Bay (DKJ), Walnut Creek, CA
| | - Leslie Ross
- Institute for Health & Aging (LR), UCSF School of Nursing, San Francisco, CA
| | - Kristine Yaffe
- Weill Institute for Neurosciences and Departments of Psychiatry (KY), Neurology and Epidemiology, UCSF, San Francisco, CA
| | - Xinhui Wang
- Department of Neurology, Keck School of Medicine (EJ, FS-G, XW, LSS, HC, JMR), University of Southern California, Los Angeles, CA
| | - Lon S Schneider
- Department of Neurology, Keck School of Medicine (EJ, FS-G, XW, LSS, HC, JMR), University of Southern California, Los Angeles, CA
| | - Helena Chui
- Department of Neurology, Keck School of Medicine (EJ, FS-G, XW, LSS, HC, JMR), University of Southern California, Los Angeles, CA
| | - John M Ringman
- Department of Neurology, Keck School of Medicine (EJ, FS-G, XW, LSS, HC, JMR), University of Southern California, Los Angeles, CA
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Okoshi A, Shinagawa S, Takasaki E, Susa Y, Inamura K, Shigeta M. Risk factors of frontotemporal dementia compared with Alzheimer disease: Single psychiatric hospital-based research in Japan. Geriatr Gerontol Int 2023; 23:932-937. [PMID: 37922917 DOI: 10.1111/ggi.14722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 10/06/2023] [Accepted: 10/16/2023] [Indexed: 11/07/2023]
Abstract
AIM The objective of this study was to reveal risk factors for incident of frontotemporal dementia (FTD) compared with Alzheimer disease (AD) in Japan. METHOD Fifty consecutive subjects diagnosed with FTD according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) under 75 years old were included retrospectively. As a control group, 48 subjects who were diagnosed with AD according to the DSM-5 and matched by age, sex, educational history, and Mini-Mental State Examination were also included. In order to examine the distinctive risk factors of FTD, we compared the relationship between symptomatologic features, Clinical Dementia Rating, clinical factors, and sociopsychological factors in the two groups. RESULT Patients with FTD were more likely than patients with AD to have meticulous premorbid personality and less likely to have a history of diabetes than patients with AD. Although the regression analysis was not significant, a history of psychiatric disorders tends to affect the incidence of FTD. CONCLUSIONS These findings regarding the risk of FTD are expected to lead to early diagnosis and care of FTD. Geriatr Gerontol Int 2023; 23: 932-937.
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Affiliation(s)
- Asaka Okoshi
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
- Department of Psychiatry, Tokyo Musashino Hospital, Institute of Psychiatry, Tokyo, Japan
| | | | - Emi Takasaki
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuko Susa
- Department of Psychiatry, Tokyo Musashino Hospital, Institute of Psychiatry, Tokyo, Japan
| | - Keisuke Inamura
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Masahiro Shigeta
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
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Demirbas M, Hahn-Pedersen JH, Jørgensen HL. Comparison Between Burden of Care Partners of Individuals with Alzheimer's Disease Versus Individuals with Other Chronic Diseases. Neurol Ther 2023; 12:1051-1068. [PMID: 37222859 PMCID: PMC10310688 DOI: 10.1007/s40120-023-00493-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/05/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Caregiving in Alzheimer's disease (AD) is often provided by informal care partners, who spend more hours per week on average than care partners of individuals with conditions other than AD. However, the burden of care in partners of individuals with AD has not been systematically compared to that of other chronic diseases. OBJECTIVE The current study therefore aims to compare the care partner burden of AD to that of other chronic diseases through a systematic literature review. METHODS Data was collected from journal articles published in the last 10 years, using two unique search strings in PubMed and analysed using pre-defined patient-reported outcome measures (PROMs) including the EQ-5D-5L, GAD-7, GHQ-12, PHQ-9, WPAI and the ZBI. The data was grouped according to the included PROMs and the diseases studied. The number of participants in the studies reporting burden of caregiving in AD was adjusted to reflect the number of participants in studies reporting care partner burden in other chronic diseases. RESULTS All results in this study are reported as a mean value and standard deviation (SD). The ZBI measurement was the most frequently used PROM to collect care partner burden (15 studies) and showed a moderate burden (mean 36.80, SD 18.35) on care partners of individuals with AD, higher than most of the other included diseases except for those characterized by psychiatric symptoms (mean scores 55.92 and 59.11). Other PROMs such as PHQ-9 (six studies) and GHQ-12 (four studies) showed a greater burden on care partners of individuals with other chronic diseases such as heart failure, haematopoietic cell transplantations, cancer and depression compared to AD. Likewise, GAD-7 and EQ-5D-5L measurements showed a lesser burden on care partners of individuals with AD compared to care partners of individuals with anxiety, cancer, asthma and chronic obstructive pulmonary disease. The current study suggests that care partners of individuals with AD experience a moderate burden, but with some variations depending on the PROMs used. CONCLUSION The results of this study were mixed with some PROMs indicating a greater burden for care partners of individuals with AD versus other chronic diseases, and other PROMs showing a greater burden for care partners of individuals with other chronic diseases. Psychiatric disorders imposed a greater burden on care partners compared to AD, while somatic diseases in the musculoskeletal system resulted in a significantly smaller burden on care partners compared to AD.
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Affiliation(s)
- Murat Demirbas
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | | | - Henrik L Jørgensen
- Department of Clinical Biochemistry, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Pei Y, Lu Y, Li H, Jiang C, Wang L. Gut microbiota and intestinal barrier function in subjects with cognitive impairments: a cross-sectional study. Front Aging Neurosci 2023; 15:1174599. [PMID: 37350810 PMCID: PMC10282132 DOI: 10.3389/fnagi.2023.1174599] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 05/22/2023] [Indexed: 06/24/2023] Open
Abstract
Background Gut-brain axis might play an important role in cognitive impairments by various diseases including Alzheimer's disease (AD). Objective To investigate the differences in gut microbial composition, intestinal barrier function, and systemic inflammation in patients with AD or mild cognitive impairment (MCI), and normal control (NC) cases. Methods A total of 118 subjects (45 AD, 38 MCI, and 35 NC) were recruited. Cognitive function was assessed using Mini-Mental State Examination (MMSE), and Montreal Cognitive Assessment Scale (MoCA). Functional ability was assessed using Activity of Daily Living Scale (ADL). The composition of gut microbiome was examined by 16S rRNA high-throughput sequencing. Phylogenetic Investigation of Communities by Reconstruction of Unobserved States (PICRUSt) was used to predict functional transfer of gut microbiota. Gut barrier dysfunction was evaluated by measuring the levels of diamine oxidase (DAO), D-lactic acid (DA), and endotoxin (ET). The serum high-sensitivity C-reactive protein (hs-CRP) level was used to indicate systemic inflammation. Results Compared with normal controls, patients with cognitive impairments (AD and MCI) had lower abundance of Dorea and higher levels of DAO, DA, and ET. Kyoto Encyclopedia of Genes and Genomes (KEGG) results showed that the pathways related to glycan biosynthesis and metabolism increased in MCI patients, while the ones related to membrane transport decreased. The abundance of Bacteroides and Faecalibacterium was negatively correlated with the content of ET, and positively correlated with the scores of MMSE and MoCA. The hs-CRP levels were similar among the three groups. A significant negative correlation was observed between the severity of gut barrier dysfunction and cognitive function. Conclusion Cognitive impairments might be associated with gut microbial dysbiosis and intestinal barrier dysfunction.
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Affiliation(s)
- Ying Pei
- Postgraduate Union Training Base of Jinzhou Medical University, PLA Rocket Force Characteristic Medical Center, Beijing, China
- Department of Neurology, PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Yan Lu
- Department of Neurology, PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - HuiZi Li
- Department of Nutrition, PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - ChengYing Jiang
- Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Lei Wang
- Department of Neurology, PLA Rocket Force Characteristic Medical Center, Beijing, China
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Kang MJY, Farrand S, Evans A, Chiu WH, Eratne D, Kelso W, Walterfang M, Velakoulis D, Loi SM. Carer burden and behavioral disturbance is similar between younger-onset Alzheimer's disease and behavioral variant frontotemporal dementia. Int Psychogeriatr 2023:1-8. [PMID: 36756758 DOI: 10.1017/s1041610222001259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
OBJECTIVES Carer burden is common in younger-onset dementia (YOD), often due to the difficulty of navigating services often designed for older people with dementia. Compared to Alzheimer's disease (AD), the burden is reported to be higher in behavioral variant frontotemporal dementia (bvFTD). However, there is little literature comparing carer burden specifically in YOD. This study hypothesized that carer burden in bvFTD would be higher than in AD. DESIGN Retrospective cross-sectional study. SETTING Tertiary neuropsychiatry service in Victoria, Australia. PARTICIPANTS Patient-carer dyads with YOD. MEASUREMENTS We collected patient data, including behaviors using the Cambridge Behavioral Inventory-Revised (CBI-R). Carer burden was rated using the Zarit Burden Inventory-short version (ZBI-12). Descriptive statistics and Mann-Whitney U tests were used to analyze the data. RESULTS Carers reported high burden (ZBI-12 mean score = 17.2, SD = 10.5), with no significant difference in burden between younger-onset AD and bvFTD. CBI-R stereotypic and motor behaviors, CBI-R everyday skills, and total NUCOG scores differed between the two groups. There was no significant difference in the rest of the CBI-R subcategories, including the behavior-related domains. CONCLUSION Carers of YOD face high burden and are managing significant challenging behaviors. We found no difference in carer burden between younger-onset AD and bvFTD. This could be due to similarities in the two subtypes in terms of abnormal behavior, motivation, and self-care as measured on CBI-R, contrary to previous literature. Clinicians should screen for carer burden and associated factors including behavioral symptoms in YOD syndromes, as they may contribute to carer burden regardless of the type.
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Affiliation(s)
- Matthew J Y Kang
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Sarah Farrand
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Andrew Evans
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Wei-Hsuan Chiu
- Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Dhamidhu Eratne
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Wendy Kelso
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Mark Walterfang
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Dennis Velakoulis
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Samantha M Loi
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
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Kang M, Farrand S, Walterfang M, Velakoulis D, Loi SM, Evans A. Carer burden and psychological distress in young-onset dementia: An Australian perspective. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5765. [PMID: 35708197 PMCID: PMC9328388 DOI: 10.1002/gps.5765] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/27/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Carer burden in dementia is associated with poor outcomes, including early nursing home placement for people with dementia and psychological distress for their carers. Carers of people with young-onset dementia (YOD) are particularly vulnerable to carer burden. Yet they are often overlooked by clinicians as dementia services are generally designed for older people. We sought to estimate the rate of burden and psychological distress in carers of YOD at a state-wide tertiary service based in Australia. METHODS We conducted a cross-sectional study examining 71 dyads from a Neuropsychiatry service. We collected patient demographic and clinical data including the Neuropsychiatry Unit Cognitive Assessment tool (NUCOG) and Mini-Mental State Examination (MMSE). Carer data, such as demographics and psychological distress, were obtained using Depression Anxiety Stress Scale 21 (DASS-21). Carer burden was rated using the Zarit Burden Inventory-short version (ZBI). RESULTS Higher carer burden, measured using ZBI, was associated with longer duration of dementia and greater severity of overall cognitive impairment. Carers who felt burdened reported higher levels of stress, depression, and anxiety measured using DASS-21. Multiple linear regression analysis found carer burden was independently predicted by duration of dementia, total cognition score and carers experiencing psychological stress. DISCUSSION We found that patient variables of dementia duration and cognitive impairment and carer variable of carer stress to be associated with carer burden. Poor executive function was associated with carer stress. Early identification and management of carer burden and psychological distress is important for outcomes. Ideally, this should be provided by a specialist YOD service.
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Affiliation(s)
- Matthew Kang
- NeuropsychiatryRoyal Melbourne HospitalParkvilleVICAustralia
- Melbourne Neuropsychiatry Centre & Department of PsychiatryUniversity of MelbourneParkvilleVICAustralia
| | - Sarah Farrand
- NeuropsychiatryRoyal Melbourne HospitalParkvilleVICAustralia
- Melbourne Neuropsychiatry Centre & Department of PsychiatryUniversity of MelbourneParkvilleVICAustralia
| | - Mark Walterfang
- NeuropsychiatryRoyal Melbourne HospitalParkvilleVICAustralia
- Melbourne Neuropsychiatry Centre & Department of PsychiatryUniversity of MelbourneParkvilleVICAustralia
| | - Dennis Velakoulis
- NeuropsychiatryRoyal Melbourne HospitalParkvilleVICAustralia
- Melbourne Neuropsychiatry Centre & Department of PsychiatryUniversity of MelbourneParkvilleVICAustralia
| | - Samantha M. Loi
- NeuropsychiatryRoyal Melbourne HospitalParkvilleVICAustralia
- Melbourne Neuropsychiatry Centre & Department of PsychiatryUniversity of MelbourneParkvilleVICAustralia
| | - Andrew Evans
- Department of NeurologyRoyal Melbourne HospitalMelbourneVICAustralia
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Huang X, Zhang M, Fang J, Zeng Q, Wang J, Li J. Classifying and characterizing the development of self-reported overall quality of life among the Chinese elderly: a twelve-year longitudinal study. BMC Public Health 2022; 22:1139. [PMID: 35672842 PMCID: PMC9175517 DOI: 10.1186/s12889-022-13314-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background To promote healthy aging, the information about the development of quality of life (QoL) is of great importance. However, the explorations of the heterogeneity in the change of QoL under the Chinese context were limited. This study aimed to identify potential different development patterns of QoL and the influential factors using a longitudinal, nationally representative sample of the Chinese elderly. Methods We adopted a five-wave longitudinal dataset from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), and a total of 1645 elderly were obtained. The sample had a mean age of 72.7 years (SD = 6.64) and was 47.2% male. Overall QoL was measured through self-report during the longitudinal process. We utilized the conditional growth mixture model (GMM) with time-invariant covariates (TICs) to explore various development patterns and associated factors. Results Three distinct trajectories of self-reported overall QoL were identified: the High-level Steady Group (17.08%), the Mid-level Steady Group (63.10%), and the Low-level Growth Group (19.82%). Results also indicated that several factors predicted distinct trajectories of self-reported overall QoL. Those elderly who received enough financial resources, had adequate nutrition, did not exhibit any disability, engaged in leisure activities, and did less physical labor or housework at the baseline were more likely to report a higher level of overall QoL over time. Conclusions There existed three development patterns of self-reported overall QoL in elders, and the findings provided valuable implications for the maintenance and improvement of QoL among the Chinese elderly. Future studies could examine the influence of other confounding factors.
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Affiliation(s)
- Xitong Huang
- School of Psychology, South China Normal University, West of Zhongshan Avenue, Tianhe District, Guangzhou City, 510631, Guangdong Province, China
| | - Minqiang Zhang
- School of Psychology, South China Normal University, West of Zhongshan Avenue, Tianhe District, Guangzhou City, 510631, Guangdong Province, China. .,Key Laboratory of Brain, Cognition and Education Sciences (South China Normal University), Ministry of Education, Guangzhou, China. .,Center for Studies of Psychological Application, South China Normal University, Guangzhou, 510631, China. .,Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, 510631, China.
| | - Junyan Fang
- School of Psychology, South China Normal University, West of Zhongshan Avenue, Tianhe District, Guangzhou City, 510631, Guangdong Province, China
| | - Qing Zeng
- School of Psychology, South China Normal University, West of Zhongshan Avenue, Tianhe District, Guangzhou City, 510631, Guangdong Province, China
| | - Jinqing Wang
- School of Psychology, South China Normal University, West of Zhongshan Avenue, Tianhe District, Guangzhou City, 510631, Guangdong Province, China
| | - Jia Li
- School of Psychology, South China Normal University, West of Zhongshan Avenue, Tianhe District, Guangzhou City, 510631, Guangdong Province, China
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Chang CC, Yeh TY, Su JA. Factors associated with the quality of life in family caregivers of people with dementia in Taiwan. TAIWANESE JOURNAL OF PSYCHIATRY 2022. [DOI: 10.4103/tpsy.tpsy_29_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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