Psychiatric disorders in spouse caregivers of care recipients with Alzheimer's disease and matched controls: A diathesis-stress model of psychopathology.

To test a diathesis-stress model of psychopathology, the authors examined the rates of current and lifetime psychiatric disorders in 82 spouse caregivers of Alzheimer's disease (AD) patients and 86 demographically matched controls. Caregivers and controls did not differ in the prevalence of disorders before the onset of care recipients' AD (or during a similar time period for the controls); caregivers experienced more depressive-anxiety disorders after the onset of patient's AD than controls. This study strongly supported the 3 key components of a diathesis-stress interaction. First, caregivers with a psychiatric history prior to the onset of patient's AD were more likely than caregivers with no history to receive a diagnosis after the onset of AD. Second, a similar relationship existed for controls. Finally, caregivers with a psychiatric history were more likely to experience a recurrence after the onset of AD than controls with a psychiatric history. These findings indicate that the diathesis of psychiatric history and the stress of caregiving interact, resulting in the observed group differences in the prevalence of psychiatric disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive predictors of incident Alzheimer's disease: A prospective longitudinal study.

The present study examined whether cognitive variables measured at baseline could predict incident cases of Alzheimer's disease (AD) after a 3-year follow-up period. Twenty-six incident AD adults and 179 very old (M?=?83.5 years) adults without dementia participated in a population-based study. Cognitive performance was indexed by the Mini-Mental State Examination (MMSE) and multiple indices of memory and visuospatial and verbal performance. A logistic regression analysis that controlled for age, gender, and education indicated that MMSE scores were reliable indicators of who would develop AD. In addition, recall of organizable words, recognition of faces, and letter fluency were reliable predictors of subsequent dementia status after differences in MMSE performance were partialed out. Thus, although the MMSE is useful in predicting dementia, there is an additional advantage of assessing specific indices of cognitive functioning. Further, supportive episodic memory tasks may be more salient predictors of incident AD than tasks that offer less supportive encoding or retrieval conditions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Appraisal and goal processes as predictors of psychological well-being in bereaved caregivers.

Narratives of 30 caregivers were scored for appraisals and coping responses following the death of their partners from AIDS. Appraisals were identified as valenced beliefs, emotions, and goal outcomes, whereas coping responses included goals and plans of action. The proportion of positive appraisals predicted long-term goals and plans and psychological well-being at both bereavement and 12 months later. Positive appraisals were correlated with positive morale and positive states of mind. The latter were negatively correlated with partner-centered, short-term plans. Positive appraisals were negatively correlated with depressive mood. Caregivers, who reported proportionately more positive appraisals during caregiving and after the loss of their partner, were more likely to have future- and self-oriented goals and plans and to demonstrate positive well-being at bereavement and better recovery 12 months later than were those who reported more negative appraisals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceived income inadequacy as a predictor of psychological distress in Alzheimer's caregivers.

The authors examined perceived income inadequacy as a predictor of self-reported depressive symptomatology and anxiety in the original sites of the Resources for Enhancing Alzheimer's Caregiver Health I project. Perceived income inadequacy, self-reported household income, and control factors (e.g., subjective health) were entered into hierarchical regression analyses predicting psychological distress. Findings suggest that perceived income inadequacy and not household income significantly predicted more self-reported depressive symptomatology and greater self-reported anxiety. This supports previous findings that objective income measures alone are not adequate indicators of socioeconomic status in older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family caregivers: Gender differences in adjustment to stroke survivors' mental changes.

Objectives: This prospective longitudinal study investigated gender differences in caregiving spouses' adjustment to the challenges of a poststroke life situation based on the caregiving stress model of Yee and Schulz (2000), which we modified. Method: The sample consisted of 97 stroke-survivor and spouse dyads who were questioned 3 months after stroke and again 1 year later. The Beck Anxiety Inventory (Beck & Steer, 1997), the Beck Depression Inventory (Beck, Steer, & Garbin, 1988), and the Giessen Complaints List (Br?hler & Scheer, 1995) were used to capture mental health and physical complaints in stroke survivors' spouses. Covariance analytical methods (analysis of covariance; ANCOVA) were conducted on data from both measuring times to test gender-related interaction effects. Results: Generally, women caregivers reported more anxiety and depressive symptoms than did their men counterparts. However, 15 months after stroke onset, in cases where individuals with stroke had substantial cognitive and mental impairments, the opposite appeared to be true. The results supported the modified caregiving stress model. Women spousal caregivers seem to adjust better to cognitive and emotional changes in their partners than did caregiving husbands. Conclusions: The rehabilitation of stroke survivors may be more successful if gender differences in caregivers' adaptation to their partners' mental changes are taken into consideration in intervention programs for families of stroke survivors. Men spousal caregivers may need counseling aimed at supporting their adjustment to stroke-related cognitive and emotional changes in their wives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Longitudinal patterns of risk for depression in dementia caregivers: Objective and subjective primary stress as predictors.

The present study examined how patterns of risk for depression over 1 year in 188 dementia caregivers (consistently asymptomatic, n ?=?88; consistently symptomatic, n ?=?40; changing risk, n ?=?60) could be predicted by objective (behavior problems of the relative) and subjective (role captivity and overload) primary stress. Results reveal that all primary stressors differentiated caregivers who remained at low levels of symptomatology over the course of 1 year from those who were at risk for experiencing a depressive disorder. In addition, caregivers' subjective experience of role captivity predicted the chronicity of risk. Findings extend prior caregiving research on patterns of depressive symptomatology by highlighting the relationship between subjective primary stressors and stability and change in caregivers' mental health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Alzheimer's Disease Assessment Scale: patterns and predictors of baseline cognitive performance in multicenter Alzheimer's disease trials

The cognitive subscale of the Alzheimer's Disease Assessment Scale (ADAS-Cog) is used as an efficacy measure in clinical drug trials of Alzheimer's disease (AD). We used data from 1,648 AD participants in two identical 26-week multicenter drug trials to examine the distribution of baseline ADAS-Cog scores in relation to selected demographic and clinical variables, Mini-Mental State Exam (MMSE), Global Deterioration Scale (GDS), and Geriatric Evaluation by Relative's Rating Instrument (GERRI) scores. At baseline, the mean (+/-SD) MMSE score was 18 +/- 4, the ADAS-Cog score was 28 +/- 11, and most subjects were in GDS stage 4 or 5. The ADAS-Cog score was statistically significantly correlated with MMSE (R = -0.76, p < 0.0001) and GERRI (R = 0.40, p < 0.0001) total scores. Correlations among the ADAS-Cog items ranged from 0.19 to 0.59 and all were statistically significant (p < 0.0001). In a multiple regression model, younger age, male gender, older age at onset of dementia, use of concurrent estrogen, and use of concurrent anti-inflammatory agents were statistically significantly associated with superior cognitive performance. We also present data on the distribution of ADAS-Cog scores in relation to subjects' age, level of education, MMSE score, and GDS stage. Because age, MMSE score, and GDS stage (and not the ADAS-Cog) are commonly used to select subjects for AD clinical trials, our data should improve the ability of sponsors to predict ADAS-Cog scores of the subjects in their trials on the basis of the inclusion criteria used. Our data also suggest that age, gender, age at onset of dementia, level of education, and use of estrogen (in women) or anti-inflammatory drugs are related to cognitive abilities in AD. Further studies are needed to assess how and when cognitive differences related to these variables arise.     

Weight loss in Alzheimer's disease: an international review of the literature

Alzheimer's disease affects an estimated 2 million elderly in the U.S. and challenges primary care physicians to assist caregivers in dealing with the daily management of these patients. To support the clinical observation of weight loss in Alzheimer patients despite adequate food intake, we reviewed the existing literature. To date, eight international studies have focused on nutrition in Alzheimer's disease and all have found weight loss. It is not clear whether this weight loss is a component of or a consequence of the disease. These findings suggest systemic, metabolic alterations in Alzheimer's disease. They require further investigation as to their nature and as to their appropriate recognition and management to retard the deteriorating effects of chronic weight loss and malnutrition. Finally, some reports lead to speculation that nutritional strategies may improve cognitive function.     

Construals of preillness relationship quality predict cardiovascular response in family caregivers of Alzheimer's disease victims.

Examined the relationships between family caregivers' construal of their pre-illness affection for and cohesiveness with an Alzheimer's disease (AD) patient and subsequent cardiovascular functioning. Scale validation demonstrated the psychometric properties. In a study conducted 2 yrs later, 31 family caregivers of AD victims performed stress-inducing tasks while cardiovascular activity was monitored. Path analyses revealed that caregivers relatively high in pre-illness affection for the AD patient were characterized by lower heart rate reactivity and resting diastolic blood pressure. In contrast, caregivers relatively high in pre-illness cohesion were characterized by higher resting systolic and diastolic blood pressure. These results suggest that caregivers' social relationships may play an important, although not always beneficial, role in cardiovascular regulation and health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The predictors of quality care

Patients' perceptions of quality are important to the performance ratings, financial viability, and operational options afforded to purchasers of health care. Through TRICARE, the Department of Defense provides care for the more than 1.5 million active duty service members charged with the defense of the nation. As patients, these service members are typically incapable of assessing the technical quality of the care they receive. This study examines the attributes of health care delivery that define military patients' perceptions of quality and discusses the implications of these assessments.     

Loss of control, self-blame, and depression: An investigation of spouse caregivers of Alzheimer's disease patients.

Tested several predictions derived from the reformulated learned helplessness (RLH) depression model developed by L. Y. Abramson et al (see record 1979-00305-001) and from recent critiques of that model, in a longitudinal study of spouses caring for a husband or wife with Alzheimer's disease. During initial interviews, 68 caregivers (aged 37–85 yrs) rated the uncontrollability of important upsetting events related to their spouse's disease and were scored on an index of internal–external causal attribution (CATN) for those events. In addition, at both the initial and follow-up interviews (n?=?38) about 10 mo later, caregivers were rated for depression, anxiety, and hostility. Results indicate that the indices of loss of control and CATN were more consistently related to depression than to anxiety or hostility, although hostility was related to CATNs. Correlations of the loss of control and CATN variables with depression remained significant after controlling for a measure of the spouse's objective disability. In hierarchical regression analyses, perceived loss of control and its interaction with CATN significantly predicted follow-up depression after controlling for initial depression. The interaction showed that loss of control combined with an internal attribution predicted higher depression than did either one alone. The importance of including specific uncontrollable events when studying the RLH model is emphasized. (36 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Narrative representations of caregivers and emotion dysregulation as predictors of maltreated children's rejection by peers.

This study examined whether maltreated children were more likely than nonmaltreated children to develop poor-quality representations of caregivers and whether these representations predicted children's rejection by peers. A narrative task assessing representations of mothers and fathers was administered to 76 maltreated and 45 nonmaltreated boys and girls (8–12 years old). Maltreated children's representations were more negative/constricted and less positive/coherent than those of nonmaltreated children. Maladaptive representations were associated with emotion dysregulation, aggression, and peer rejection, whereas positive/coherent representations were related to prosocial behavior and peer preference. Representations mediated maltreatment's effects on peer rejection in part by undermining emotion regulation. Findings suggest that representations of caregivers serve an important regulatory function in the peer relationships of at-risk children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sociodemographic and psychological predictors of changes in dietary fat consumption in adults with high blood cholesterol following counseling in primary care.

The associations between sociodemographic variables, psychological factors, and changes in dietary fat consumption over 4 months were assessed in a randomized controlled trial of behavioral counseling versus standard advice. Patients were 141 men and 150 women, with an average age of 52.1 years and total cholesterol level of 7.27 mmol/l (278 mg/dl). Smokers, younger patients, and those with greater body mass index had higher fat intake at baseline. Behavioral counseling led to greater reductions in fat intake than did standard advice. Self-efficacy and ratings of benefits of low-fat diets were related to fat consumption at baseline, and changes in these measures were correlated with changes in fat intake. Family support, baseline anticipated regret, and (for the behavioral counseling group only) baseline behavioral intentions predicted reductions in fat intake. The results indicated that psychosocial variables associated cross-sectionally with fat consumption do not necessarily predict change and that factors involved in the process of change and the prediction of change need to be differentiated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship orientation, quality of prior relationship, and distress among caregivers of Alzheimer's patients.

Communal orientation and closeness of the caregiver–patient relationship were investigated as predictors of distress among caregivers of Alzheimer's patients. Persons high in communal orientation were less depressed than those low in communal orientation. Caregivers reporting a close relationship with the patient before illness onset felt less burdened than those whose relationship had not been close. Communal orientation interacted with closeness when data were analyzed separately for men and women. Among men, being low in communal orientation and having a relatively poor prior relationship were associated with the highest levels of depression, levels that put them at risk for clinical depression. Among women low in communal orientation, higher levels of depression were related to having a close relationship with the patient. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A continuum of care in Alzheimer's disease

This article describes the care and service needs of persons with Alzheimer's disease. In particular, it discusses the advanced nurse practitioner's clinical, educational, and research roles in maintaining the health of these individuals with cognitive impairments over the disease trajectory. Four stages of the disease are identified: early, middle, late, and terminal. Patient symptoms, family caregiver needs, and the role of the advanced nurse practitioner during each stage are articulated.     

Quality of center day care and attunement between parents and caregivers: center day care in cross-national perspective

The efferent projections from the periaqueductal gray matter (PAG) to the parabrachial nucleus (PB) were studied in the rat following microinjections of the anterograde axonal tracer Phaseolus vulgaris-leucoagglutinin (PHA-L) into restricted regions of the PAG. The dorsomedial and dorsolateral PAG columns project almost exclusively to the superior lateral PB subnucleus, whereas the lateral and ventrolateral PAG columns project to five lateral PB sites: dorsal lateral subnucleus, medial and lateral crescent areas (which flank the dorsal lateral PB subnucleus), central lateral subnucleus (rostral portion), and superior lateral subnucleus. The PAG region lying near the cerebral aqueduct projects to five lateral PB sites: external lateral subnucleus (inner subdivision), medial and lateral crescent areas, central lateral subnucleus (rostral portion), and dorsal lateral subnucleus. The internal lateral PB subnucleus, which projects exclusively to the intralaminar thalamic nuclei, and the K?lliker-Fuse nucleus were not innervated by the PAG. The PAG selectively innervates individual PB subnuclei that may be part of the spino-parachio-forebrain pathway. All PAG columns, including the aqueductal region, project to the superior lateral PB subnucleus, a presumed nociceptive relay site that receives inputs from multiple spinal cord regions (laminae I, V, and VIII) and projects to the ventromedial and retrochiasmatic hypothalamic areas-two regions that have been implicated in complex goal-directed behavior (e.g., food intake and reproductive function). Earlier studies demonstrated that the dorsal lateral and external lateral PB subnuclei (inner division) receive overlapping inputs from the superficial dorsal horn (laminae I and II) and the nucleus tractus solitarius, and both PB subnuclei send projections to limbic forebrain areas (e.g., hypothalamus, preoptic region, amygdala). Because the PAG projects to both of these PB subnuclei, this projection system possibly functions as a behavioral state-dependent filter system that modulates ascending nociceptive and/or visceral information as it is relayed through the PB to forebrain sites.     

Effect of respite care on dementia and nondementia patients and their caregivers.

The impact of a respite program on the cognitive and physical functioning of dementia and nondementia patients, and on the burden perceived by their caregivers, was assessed in a pretest–posttest design. A total of 55 caregivers were interviewed twice, 5 weeks apart. In the respite group, the caregiver's patient experienced a 2-week respite stay in a nursing home during the 5-week interval, whereas in the waiting-list comparison group, the patient experienced ongoing in-home care during the interval. We hypothesized that patient diagnosis (dementia vs. nondementia) would interact with respite exposure, with nondementia patients showing more improvement from respite than dementia patients. Regardless of diagnosis, however, positive effects from respite exposure were found for caregiver reports of the patient's memory and behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality counts for a lot: predictors of mental and physical health of spouse caregivers in two disease groups

The purpose of this study were to examine the influence of personality on mental and physical health of spouse caregivers and to determine whether there were differences in such influences depending on disease context. The disease contexts compared were Alzheimer's disease (AD) and Parkinson's disease (PD; with no coexisting dementia)--both chronic, degenerative diseases of later life. It was predicted that personality would be related to mental and physical health, directly and indirectly, and that AD caregivers would have higher levels of perceived stress and worse mental and physical health outcomes. Participants in the study were 175 caregivers (88 AD; 87 PD) living at home with their ill spouses. The data provided an excellent fit to the hypothesized model of the relationships between personality, disease group, social support, perceived stress, and mental and physical health. Seventy-eight percent of the variance in mental health was accounted for and 35% of the variance in physical health was explained. Personality had significant direct and indirect effects on mental health and significant indirect effects on physical health. As predicted, AD caregivers had significantly worse mental health than PD caregivers; however, AD caregivers had better physical health than PD caregivers, controlling for other variables in the model. These results are discussed in relation to the existing caregiving and behavioral medicine literature. Future research should include different domains of personality--states and longer term self-regulatory processes in addition to traits--to advance models of caregiving processes further.