Dynamic structural equation modelling evaluating the progressively lowered stress threshold as an explanation for behavioural symptoms of dementia.

Care recipients were not participants, so their stress exposure and behaviours were reported by caregivers, which may introduce reporting bias. The study was observational, so it shows daily associations, not that abuse, neglect or stress caused more dementia behaviours. The sample was a convenience sample of US caregivers who co-resided, spoke English or Spanish, and were mostly female and White, so it may not represent all families. 18% of diary days were missing, although the model used repeated daily reports and handled missing responses. Diaries were completed once daily, so the study could not test within-day changes or the idea that stress tolerance varies from morning to evening. The model used only a 1-day lag, so it cannot show how long the next-day effect lasts. Other environmental stressors such as sleep, noise, temperature and social isolation were not measured.

The authors disclosed no conflicts. The study was funded by the National Institute on Aging.

Do not read these links as proof that abuse or neglect causes more dementia behaviours. The study observed daily associations in caregiver reports, not a randomised intervention, and the care recipient's stress exposure was measured by caregiver self-report.