Background: There is limited evidence on caregiver outcomes associated with mild cognitive impairment in patients
with Parkinson’s disease (PD-MCI) and the coping strategies used by these caregivers.
Methods: To investigate this relationship, we examined levels of burden, depression, anxiety, coping strategies
and positive aspects of caregiving in the informal caregivers of 96 PD patients. The PD patients were classified
using MDS-Task Force Level II criteria as showing either normal cognition (PD-N; n = 51), PD-MCI (n = 30) or
with dementia (PDD; n = 15).
Results: Mean Zarit Burden Interview (ZBI) score increased significantly between carers of PD-N (M = 13.39, SD = 12.22)
compared to those of PD-MCI patients (M = 22.00, SD = 10.8), and between carers of PD-MCI and PDD patients
(M = 29.33, SD = 9.59). Moreover, the proportion of carers showing clinically significant levels of burden (ZBI
score ≥ 21) also increased as the patients’ cognitive status declined (18% for PD-N; 60% for PD-MCI; and 80% for
PDD) and was mirrored by an increasing amount of time spent providing care by the caregivers. Caregiver ZBI
score was independent of patient neuropsychiatric symptoms, motor function, disease duration and time that
caregivers spent caregiving. Caregiver use of different coping strategies increased with worsening cognition. However, we
found only equivocal evidence that the use of problem-focused, emotion-focused and dysfunctional coping mediated
the association between patient cognitive status and caregiver burden, because the inverse models that used caregiver
burden as the mediator were also significant.
Conclusions: The study highlights the impact of Parkinson’s disease on those providing care when the patient’s
cognition is poor, including those with MCI. Caregiver well-being has important implications for caregiver
support, nursing home placement and disease course.

• Caregiver burden is increased in Parkinson’s disease with mild cognitive impairment (PD-MCI)