**6.3 Care burden**

As PD progresses, the cognitive impairment advances leading to higher strain [83], burden [5, 76, 78, 106, 109] and stress [82] in care partners. The main contributors to care partner burden and stress in people with PDD were the person's neuropsychiatric symptoms (i.e. depression, psychotic symptoms) [78, 82] and cognitive decline [5, 76, 109, 110]. Apathy, a common and often under-recognised neuropsychiatric complication of PDD and DLB, is strongly associated with care burden [111], in part due to emotional blunting that is one of the dimensions of the apa0thy syndrome [112].
