INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY Int J Geriatr Psychiatry 2002; 17: 78±84. DOI: 10.1002/gps.524 The psychosocial burden on spouses of the elderly with stroke, dementia and Parkinson's disease Bente Thommessen 1 *, Dag Aarsland 2 , Anne Braekhus 3 , Anne Rita Oksengaard 1 , Knut Engedal 3 and Knut Laake 1 1 Department of Geriatric Medicine, Ullevaal Hospital, Oslo, Norway 2 Section of Geriatric Psychiatry, Rogaland Psychiatric Hospital, Stavanger, Norway 3 The Norwegian Centre for Dementia Research SUMMARY Objective To characterize the psychosocial burden on spouses living with the elderly suffering from mild dementia, stroke and Parkinson's disease, and to identify patient characteristics associated with it. Materials and methods Data on patientÐspouse couples came from three studies of patients with stroke 36 couples), mild dementia 92 couples) and Parkinson's disease 58 couples). The psychosocial burden was recorded by the 15Ðitem Relatives' Stress Scale RSS). A factor analysis of this instrument produced a one-factor solution CFI  0.98) consisting of eight items with good face validity and acceptable reliability within each diagnostic group Cronbach's alpha range 0.66± 0.69). Covariates of this factor were identi®ed using structural equation modeling SEM) by regression on patient's age, gender, cognitive function MMSE), activities of daily living ADL) and depressive symptoms MADRS). Results Disorganization of household routines, dif®culties with going away for holidays, restrictions on social life, and the disturbances of sleep were the most frequently reported problems in all three groups. According to the mean sumscore on the RSS, the perceived psychosocial burden was similar across the diagnostic groups. In the ®nal SEM model, a lower cognitive function of the patient was associated with a higher psychosocial burden on the spouses of patients with stroke   1.3, p  0.01) and Parkinson's disease   0.89, p < 0.01), while in the dementia group, only an insigni®cant trend was demonstrated. In the dementia group, a signi®cantly higher burden was identi®ed on female spouses   0.56, p  0.04). A heavier burden of care was also associated with depressive symptoms in the patients with Parkinson's disease. In neither group did the ®nal model disclose any effect of ADL function on the spouse's psychosocial burden. Conclusion Spouses caring for patients with dementia, stroke and Parkinson's disease perceive a similar type and level of psychosocial burden, independent of the disease. The cognitive functioning of the patient is a particularly important factor in this, especially when caring for patients with stroke or Parkinson's disease. Copyright # 2002 John Wiley & Sons, Ltd. key words Ðcarer burden; cognitive impairment; elderly; stroke; mild dementia; Parkinson's disease The impact of informal caregiving on family mem- bers of chronically disabled elderly people is being increasingly focused, partly because of the ongoing shift from institutional to community care Vrabec, 1997; Han and Haley, 1999). More of the frail elderly are cared for in their own homes, and many are to a great extent the primary responsibility of informal caregivers like spouses and children Brereton, 1997). Research into the consequences of this has dis- closed potentially negative effects on the well-being of the caregiver Carnwath and Johnson, 1987; Anderson et al., 1995; Schulz et al., 1995; Dennis et al., 1998; Dunkin and Anderson-Hanley, 1998; Schulz and Beach, 1999; Thompson and Thompson, 1999). Dementia, stroke and Parkinson's disease are highly prevalent in old age Fratiglioni et al., 1999; MacDonald et al., 2000). Of these, dementia and Parkinson's disease are progressive, while stroke has Received 1 February 2001 Copyright # 2002 John Wiley & Sons, Ltd. Accepted 18 June 2001 *Correspondence to: Dr B. Thommessen, Department of Geriatric Medicine, Ullevaal Hospital, 0407 Oslo, Norway. Tel: 004722118677. Fax: 004722118701. E-mail: bente.thommessen@ioks.uio.no