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Objectives: We investigated homecare patients with dementia of Alzheimer's type (DAT; n = 36) or vascular dementia (VD; n = 36) and their care-providing relatives regarding clinical and psychosocial variables to determine whether DAT and VD impose different burdens on caregivers., Method: All patients were diagnosed according to ICD-10 criteria. The diagnoses were confirmed by internal medical, clinical-neurological, and psychiatric parameters. The severity of the dementias was graded according to the Global Deterioration Scale (GDS). Caregiving relatives responded to the Behavioral Pathology in Alzheimer's Disease Rating Scale (BAD), the Blessed Dementia Scale (BDS), and the Screen for Caregiver Burden (SCB)., Results: Analyses revealed that caregivers' burden (SCB), disease symptoms and personality changes of patients (BAD), and the patients' inability to cope with everyday tasks (BDS) were sharply higher for DAT than for VD patients in the group with severe dementia. Concerning patients with mild or moderately severe disease, scores in the DAT group were similar or lower than those in the VD group., Conclusion: In early stages, VD patients impose a greater burden on relatives than do patients with DAT. In severe stages this relationship undergoes a reversal, with relatives of DAT patients experiencing the burden more adversely than those of VD patients. The differences in the onset and course characteristics, as well as the specific differences between these two types of dementia with respect to caregiver burden factors, call for their diagnostic separation and the development of specific homecare support systems for family caregivers.

Thirty-six homecare patients with dementia of Alzheimer type (DAT) and their caregiving relatives were studied to determine the factors influencing their use or nonuse of available medical, institutional, instrumental, and legal supports. The rate of utilization of homecare support was found to be surprisingly low. Only when the burden of providing care had become intolerable did relatives resort to homecare support (homecare allowance, counseling, outpatient services, etc.). The main reason for the low utilization was poor knowledge regarding the availability of homecare supports. Since all of the DAT patients were under the care of a family doctor, this information deficit could best be overcome by improved counseling from personal physicians.