How does carer management style influence the performance of activities of daily living in people with dementia?

Introduction: People with Dementia (PwD)'s performance of activities of daily living (ADLs) has been associated with apathy, cognitive deficits, carers' depression and burden. However, it is not known if the carers' management style affects ADL performance, particularly alongside PwD's cognitive deficits and apathy. Thus, the aim of this study was to explore the contribution of intrinsic (cognition, apathy) and extrinsic (carer management styles) dementia factors to ADL performance. Methods: PwD (n = 143) were assessed on global cognition (ACE-III); apathy (CBI-R); ADLs (Disability Assessment for Dementia-DAD). Carers' (n = 143) criticism, encouragement and active-management styles were assessed with the Dementia Management Strategy Scale (DMSS). Multiple linear regression analysis investigated contributions of carer styles, cognition, apathy (independent variables) on ADLs (dependent variable). Results: The best model explaining the variance of the DAD scores included cognition (β = 0.413, t ₍₁₄₂₎ = 4.463, p = 0.001), apathy (β = –0.365, t ₍₁₄₂₎ = –5.556, p = 0.001), carer criticism (β = –0.326, t ₍₁₄₂₎ = –2.479, p = 0.014) and carer encouragement styles (β = 0.402, t ₍₁₄₂₎ = 2.941, p = 0.004) accounting for 40% of the variance of the DAD scores. Conclusions: This novel study demonstrated that PwD's level of apathy and the carer's use of criticism negatively affected ADL performance while PwD's cognitive abilities and carer encouragement style improved ADL performance. These findings have critical implications for the development of novel multi-component non-pharmacological interventions to maintain function and delay disease progression in dementia, as well as direct relevance to current carers and families.