Association between caregiving status and cognitive function as well as activities of daily living among community-dwelling older adults with Alzheimer's disease: A cross-sectional study

BackgroundAlzheimer's disease is associated with progressive cognitive decline and impaired activities of daily living. Professional institutional care and family home care are common long-term care models, but their associations with patient outcomes and potential mediating pathways remain unclear.ObjectiveTo examine the associations of care model with cognitive function and activities of daily living in patients with mild-to-moderate Alzheimer's disease and to assess the mediating roles of neuropsychiatric symptoms and social support.MethodsThis cross-sectional study included 309 patients: 194 receiving professional institutional care and 115 receiving family home care. Cognition, daily functioning, neuropsychiatric symptoms, and social support were assessed using standardized scales. Multiple linear regression, propensity score matching, bootstrap mediation analysis, and subgroup analyses were performed.ResultsAfter full adjustment, professional institutional care was associated with higher Montreal Cognitive Assessment scores (β=1.87, 95% confidence interval [CI] 0.87-2.87; p < 0.001) and lower Activities of Daily Living scores (β=-3.04, 95% CI -5.16 to -0.92; p = 0.005). Propensity score matching yielded consistent results. Neuropsychiatric symptoms mediated 22.37% of the association with daily functioning, whereas social support did not show a significant mediating effect. Associations were consistent across subgroups.ConclusionsProfessional institutional care was associated with better cognition and greater independence in daily living, partly through fewer neuropsychiatric symptoms. Because of the cross-sectional design, these findings do not establish causality.