**8. Dyadic relationships in LBD**

Both dementia and PD have a profound effect on the person, the care partner and their relationship [156]. People with PD have reported significant reduction in sexual functions, although the non-sexual relationship aspects, for example talking about one's feelings or tenderness, increased with the duration of the disease [157]. Men with PD tend to withdraw from the relationship, may have had increased thoughts of divorce and may have reported dissatisfaction with the relationship and sexuality since the onset of PD, more so than women with PD [157]. Mutuality, defined as the positive quality of a partnership consisting of love and affection, reciprocity, shared values and shared pleasurable activities [158], remains relatively high at mild to moderate stages of PD but can be significantly lower at an advanced stage of PD [83, 159]. Likewise, in another study, both partners' mutuality levels were similar but people with PD reported higher reciprocity than their partners [159]. Mutuality, alongside with non-motor symptoms, was also found to be a predictor of health-related quality of life for people with PD, whereas mutuality and cognition were the main predictors of burden in life partners [159]. These studies highlight that the impact of PD on the couple is substantial.

The advancing nature of dementia increases the person's memory loss, confusion, agitation and inability to communicate, which may lead them to not recognising one's partner and forgetting that they are married [129]. As a consequence, the life partner might start to doubt whether the marriage still exists [129]. Thus, the central theme describing relationships within dementia is often 'loss'–loss of a

person, relationship, mutual companionship and connectedness [123, 129]. This theme also applies in PD as life partners of people with PD experienced feelings of loss and helplessness and felt overwhelmed and unable to cope with the cognitive impairment of the care recipient [39], highlighting that once cognition has started to decline, the impact is more profound compared to intact PD.

Neurodegenerative conditions, such as PDD and DLB, can challenge a couple and impact negatively on relationship quality and lead to dissatisfaction even more than other diseases due to its incurable and progressive nature. Evidence outside of PD has revealed that one partners' depression can contribute to relationship dissatisfaction, lower levels of communication and problem-solving abilities as well as difficulties maintaining intimacy [160]. In turn, higher loss of intimacy can lead to higher levels of depression [161]. Similarly, lower marital quality in people with PD can contribute to higher anxiety in life partners [162]. In cognitively intact people with PD, the motor symptoms had a significant impact on the relationship [163] but when cognitive decline had emerged, non-motor symptoms were the most prominent stressors on couples' relationships [159]. In order to overcome the challenges and sustain relationships, efficient and effective coping strategies are required. Lack of these strategies can lead to increased burden and health issues in the care partner, institutionalisation of the person with LBD and eventually relationship breakdown [164].

Importantly, having a close relationship with one's partner can be protective. More satisfaction with intimacy was associated with less stress and fewer depressive symptoms, particularly in female care partners [165]. In PD, higher mutuality was related to better mental health outcomes for partners, lower PD severity as well as lower burden and higher quality of life in the care partner [163]. The ability to remain positive when having PD or living with a care recipient who has PD has been found to contribute to higher marital quality for the couple [162]. These findings resonate with Habermann's [166] study who stated that PD affected couples' closeness and communication positively. Despite these encouraging findings, PD has been found to have a detrimental effect on the relationship and lead to poor marital adjustment [167]. Thus, further research is required to explore the consequences of PD and LBD on the person, life partner and their relationship.

#### **9. Conclusion**

This chapter has highlighted the profound impact of LBD on life partners, in particular due to psychiatric and cognitive symptoms of people with PDD and DLB which intensify with the progression of cognitive impairment in PD. As a result of providing care to people with LBD, life partners experience burden, stress, poor mental health, negative feelings and relationship dissatisfaction, and for many life partners their life had changed as a result of becoming a care partner. There is currently minimal targeted support available to couples within LBD but in light of the protective nature of good relationships, future studies should focus on supporting intimate relationships resulting in more positive outcomes for both partners.

**49**

**Author details**

United Kingdom

Sabina Vatter1

provided the original work is properly cited.

and Iracema Leroi1,2\*

\*Address all correspondence to: iracema.leroi@tcd.ie

*Long-Term Partnerships in Lewy Body Dementias DOI: http://dx.doi.org/10.5772/intechopen.86204*

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

Experimental Psychology, School of Biological Sciences, University of Manchester,

1 Faculty of Biology, Medicine and Health, Division of Neuroscience and

2 Global Brain Health Institute, Trinity College Dublin, Ireland

### **Conflict of interest**

The authors have no financial conflicts. This chapter is based on a doctoral thesis [168]. *Long-Term Partnerships in Lewy Body Dementias DOI: http://dx.doi.org/10.5772/intechopen.86204*

*Geriatric Medicine and Gerontology*

person, relationship, mutual companionship and connectedness [123, 129]. This theme also applies in PD as life partners of people with PD experienced feelings of loss and helplessness and felt overwhelmed and unable to cope with the cognitive impairment of the care recipient [39], highlighting that once cognition has started

Neurodegenerative conditions, such as PDD and DLB, can challenge a couple and impact negatively on relationship quality and lead to dissatisfaction even more than other diseases due to its incurable and progressive nature. Evidence outside of PD has revealed that one partners' depression can contribute to relationship dissatisfaction, lower levels of communication and problem-solving abilities as well as difficulties maintaining intimacy [160]. In turn, higher loss of intimacy can lead to higher levels of depression [161]. Similarly, lower marital quality in people with PD can contribute to higher anxiety in life partners [162]. In cognitively intact people with PD, the motor symptoms had a significant impact on the relationship [163] but when cognitive decline had emerged, non-motor symptoms were the most prominent stressors on couples' relationships [159]. In order to overcome the challenges and sustain relationships, efficient and effective coping strategies are required. Lack of these strategies can lead to increased burden and health issues in the care partner, institutionalisation

to decline, the impact is more profound compared to intact PD.

of the person with LBD and eventually relationship breakdown [164].

PD and LBD on the person, life partner and their relationship.

Importantly, having a close relationship with one's partner can be protective. More satisfaction with intimacy was associated with less stress and fewer depressive symptoms, particularly in female care partners [165]. In PD, higher mutuality was related to better mental health outcomes for partners, lower PD severity as well as lower burden and higher quality of life in the care partner [163]. The ability to remain positive when having PD or living with a care recipient who has PD has been found to contribute to higher marital quality for the couple [162]. These findings resonate with Habermann's [166] study who stated that PD affected couples' closeness and communication positively. Despite these encouraging findings, PD has been found to have a detrimental effect on the relationship and lead to poor marital adjustment [167]. Thus, further research is required to explore the consequences of

This chapter has highlighted the profound impact of LBD on life partners, in particular due to psychiatric and cognitive symptoms of people with PDD and DLB which intensify with the progression of cognitive impairment in PD. As a result of providing care to people with LBD, life partners experience burden, stress, poor mental health, negative feelings and relationship dissatisfaction, and for many life partners their life had changed as a result of becoming a care partner. There is currently minimal targeted support available to couples within LBD but in light of the protective nature of good relationships, future studies should focus on supporting intimate relationships resulting in more positive outcomes for both partners.

**48**

**9. Conclusion**

**Conflict of interest**

The authors have no financial conflicts.

This chapter is based on a doctoral thesis [168].
