Effect of multicomponent interventions on caregiver burden and depression: The REACH multisite initiative at 6-month follow-up.

Meta-analysis was used to examine pooled parameter estimates of 9 active compared with 6 control conditions of the Resources for Enhancing Alzheimer's Caregiver Health (REACH) project at 6 months on caregiver burden and depressive symptoms. Associations of caregiver characteristics and outcomes were examined. For burden, active interventions were superior to control conditions (p=.022). Also, active interventions were superior to control conditions for women versus men and for caregivers with lower education versus those with higher education. For depressive symptoms, a statistically significant association of group assignment was found for Miami's family therapy and computer technology intervention (p=.034). Also, active interventions were superior to control conditions for Hispanics, nonspouses, and caregivers with lower education. Results suggest interventions should be multicomponent and tailored. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Expressed emotion and familial interaction: A study with agoraphobic and obsessive-compulsive patients and their relatives.

Patients with panic disorder with agoraphobia (n = 40) or obsessive- compulsive disorder (n = 61) participated in a 10-min problem-solving interaction with their primary relative. Relatives were categorized as hostile or nonhostile toward the patient on the basis of a measure of expressed emotion (EE). Observed interactions between patients and their hostile relatives, relative to those of dyads with a nonhostile relative, were marked by higher rates of relatives' criticism and of patients' negativity but not by higher rates of negative reciprocity. Analyses of sequences indicated that the dyads with a hostile relative had a higher rate of sequences in which the relative was first critical and the patient then negative than was the case for dyads with nonhostile relatives. Moreover, hostile relatives were more frequently critical than nonhostile relatives whether patients' preceding behavior was positive, negative, or neutral. The findings are consistent with the stress-vulnerability model of the effect of EE on mental health, in that patients living with a high EE relative appear to be exposed to higher levels of interpersonal stress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Attribution and expressed emotion in the relatives of patients with schizophrenia": Correction to Brewin, MacCarthy, Duda, and Vaughn (1991).

Reports an error in "Attribution and expressed emotion in the relatives of patients with schizophrenia" by Chris R. Brewin, Brigid MacCarthy, Karin Duda and Christine E. Vaughn (Journal of Abnormal Psychology, 1991[Nov], Vol 100[4], 546-554). An incorrect sentence was published. The sentence that ends the fourth paragraph on p. 547 ought to read: A more recent onset of illness would be expected to produce more unstable attributions, and more disturbed behavior (particularly involving violence toward the relative) would be expected to produce attributions that were more internal and personal to the patient but more external and uncontrollable as regards the relative. (The following abstract of the original article appeared in record 1992-12907-001.) Indexes of expressed emotion (EE) in 58 relatives of patients with schizophrenia were related to those relatives' spontaneously expressed causal beliefs about the illness and about related symptoms and behaviors. Relatives made attributions predominantly to factors external, universal, and uncontrollable from their own perspective, and to factors internal, universal, and uncontrollable from the patient's perspective. Low-EE relatives were similar in their attributions to emotionally overinvolved relatives. Compared with these 2 groups, critical and/or hostile relatives made more attributions to factors personal to and controllable by the patient. Subsequent analyses suggested that hostile relatives were further characterized by making more attributions to factors internal to the patient and by making attributions with fewer causal elements. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Expressed emotion and sociocultural moderation in the course of schizophrenia.

This study examined whether the sociocultural context moderates the relationship between families' expressed emotion (EE) and clinical outcomes in schizophrenia. In a sample of 60 Mexican American caregivers and their ill relatives, we first assessed whether EE and its indices (criticism, emotional overinvolvement [EOI], and warmth) related to relapse. Second, we extended the analysis of EE and its indices to a longitudinal assessment of symptomatology. Last, we tested whether bidimensional acculturation moderated the relationship between EE (and its indices) and both relapse and symptom trajectory over time. Results indicated that EOI was associated with increased relapse and that criticism was associated with increased symptomatology. Additionally, as patients' Mexican enculturation (Spanish language and media involvement) decreased, EE was increasingly related to relapse. For symptomatology, as patients' U.S. acculturation (English language and media involvement) increased, EE was associated with increased symptoms longitudinally. Our results replicate and extend past research on how culture might shape the way family factors relate to the course of schizophrenia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the special section on Resources for Enhancing Alzheimer's Caregiver Health (REACH).

This article provides background information and an overview on Resources for Enhancing Alzheimer's Caregiver Health (REACH) a multisite intervention trial for caregivers of persons with Alzheimer's disease designed to reduce caregiver burden and depression. REACH is the largest randomized controlled clinical trial to date, involving 1,222 caregiver and care recipient dyads recruited from 6 different sites in the United States. The authors describe the design of the study, summarize the interventions implemented at each site, and provide an overview of the 4 articles in this special section. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Inference of beliefs and emotions in patients with Alzheimer's disease.

The present study compared 20 patients with mild to moderate Alzheimer's disease with 20 older controls (ages 69-94 years) on their ability to make inferences about emotions and beliefs in others. Six tasks tested their ability to make 1st-order and 2nd-order inferences as well as to offer explanations and moral evaluations of human action by appeal to emotions and beliefs. Results showed that the ability to infer emotions and beliefs in 1st-order tasks remains largely intact in patients with mild to moderate Alzheimer's. Patients were able to use mental states in the prediction, explanation, and moral evaluation of behavior. Impairment on 2nd-order tasks involving inference of mental states was equivalent to impairment on control tasks, suggesting that patients' difficulty is secondary to their cognitive impairments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Misattribution errors in Alzheimer's disease: The illusory truth effect.

Patients with mild Alzheimer's disease (AD) and age-matched controls were compared on a series of tasks designed to measure errors of misattribution, the act of attributing a memory or idea to an incorrect source. Misattribution was indexed through the illusory truth effect, the tendency for participants to judge previously encountered information to be true. Cognitive theories have suggested that the illusory truth effect reflects the misattribution of experimentally produced familiarity (a nonspecific sense that an item has been previously encountered) to the veracity of previously encountered information. Consistent with earlier suggestions that AD impairs both familiarity and recollection (specific memory for contextual details of the study episode), AD patients demonstrated significantly fewer misattribution errors under conditions in which the illusory truth effect is thought to rely on relative familiarity (uncued condition), but more misattribution errors under conditions thought to rely on relative amounts of contextual recollection (cued condition). These results help further specify the precise nature of memory impairments in AD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Expressed emotion and attributions in the relatives of bipolar patients: An analysis of problem-solving interactions.

Among the relatives of schizophrenic and depressed patients, high expressed emotion (EE) attitudes are associated with "controllability attributions" about the causes of patients' symptoms and problem behaviors. However, previous studies have judged EE attitudes and causal attributions from the same assessment measure, the Camberwell Family Interview (CFI; C. E. Vaughn and J. P. Leff, 1976). The authors examined causal attributions among relatives of 47 bipolar patients, as spontaneously expressed to patients in family problem-solving interactions during a postillness period. Relatives rated high EE during the patients' acute episode (based on the CFI) were more likely than relatives rated low EE to spontaneously attribute patients' symptoms and negative behaviors to personal and controllable factors during the postillness interactional assessment. Thus, the EE-attribution linkage extends to the relatives of bipolar patients evaluated during a family interaction task. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Categorization of novel animals by patients with Alzheimer's disease and corticobasal degeneration.

We taught a novel animal category by rule-based and similarity-based processes to participants with Alzheimer's disease (AD), corticobasal degeneration (CBD), and healthy age-matched participants. Healthy participants successfully categorized by either process. AD patients' rule-based categorization was impaired, while their similarity-based categorization resembled that of healthy participants. Correlations of AD patients' performance with measures of executive functioning suggested a deficit in the cognitive resources necessary for engaging rule-based categorization. The contribution of limited executive resources to categorization difficulty in AD was further demonstrated in a second experiment in which features determining category membership were of lower salience. CBD patients were relatively impaired at similarity-based processing, suggesting that qualitatively distinct categorization processes can be selectively compromised in patients with focal neurodegenerative diseases. Moreover, AD patients' impaired categorization correlated with performance on a measure of semantic memory, implicating this categorization deficit in AD patients' semantic memory difficulty. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping style, perceived uncertainty in illness, and distress in individuals with Parkinson's disease and their caregivers.

Examined the relationship of coping style and illness uncertainty to psychological distress in individuals with Parkinson's disease (PD) and their primary caregivers. Design: Correlational methods, within-group theory-driven hierarchical regression analyses, and transactional analyses. Ss were 44 dyads composed of individuals with PD and their caregivers. Main Outcome Measures: Hoehn and Yahr Clinical Disability Rating Scale, Instrumental Activities of Daily Living Scale, Symptom Distress Checklist-90—Revised, Mischel Uncertainty in Illness Scale-Community Form, and Revised Ways of Coping Checklist. Results: Emotion-focused coping was associated with higher levels of distress for persons with PD, whereas both emotion-focused coping and perceived uncertainty were associated with distress for the caregivers. Transactional analyses between patients and caregivers indicated that higher levels of patient problem-focused coping and perceived uncertainty in illness were associated with increased problems in caregiver distress. Adjustment to PD is influenced by several patient and caregiver variables. The results warrant consideration of a variety of clinical interventions involving patient and caregiver education about the disease and methods for managing the associated symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A sociocultural stress, appraisal, and coping model of subjective burden and family attitudes toward patients with schizophrenia.

A sociocultural stress, appraisal, and coping model was developed to understand relatives' burden of care and negative affective attitudes toward patients with schizophrenia. Ninety-two African American and 79 White patients and a significant other (80% mothers) completed 2 10-min family problem-solving discussions. In addition, the Kreisman Rejection Scale and a global self-report rating of family burden were administered to relatives, and a self-report rating of substance use was administered to patients. Results indicated that subjective burden of care and patients' odd and unusual thinking during the family discussion each independently predicted relatives' attitudes toward patients, suggesting that negative attitudes are based in part on both patients' symptoms and perceived burden of care. African American relatives' perceived burden was also predicted by patients' substance abuse. Finally, White family members were significantly more likely than African Americans to feel burdened by and have rejecting attitudes toward their schizophrenic relative suggesting that cultural factors play an important role in determining both perceived burden and relatives' attitudes toward patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Missing the mark: Effects of time and causal attributions on goal revision in response to goal-performance discrepancies.

In an attempt to extend past goal setting research, the present study examined the influence of goal-performance discrepancies (GPDs), causal attributions, and temporal factors on the process of dynamic self-regulation. Goal revision processes were examined longitudinally in a sample of 100 varsity-level college track and field athletes over the course of an 8-week competitive season. The results indicate that an individual's GPD significantly predicted the amount of goal revision engaged in by the athletes, such that participants were more likely to lower their competition (proximal) and season (distal) goals when they failed to reach these goals and their respective GPDs were large. However, as hypothesized, this relationship was moderated by stability attributions and the temporal location of the individual with respect to the time period allotted for goal attainment. Implications for future research in the area of goal setting and dynamic self-regulation are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

False recognition of pictures versus words in Alzheimer's disease: The distinctiveness heuristic.

False recognition of semantic associates can be reduced when older adults also study pictures representing each associate. D. L. Schacter, L. Israel, and C. Racine (1999) attributed this reduction to the operation of a distinctiveness heuristic: a response mode in which participants demand access to detailed recollections to support a positive recognition decision. The authors examined patients with probable Alzheimer's disease (AD) and older adults with this paradigm. Half of the participants studied pictures and auditory words; the other half studied visual and auditory words. Older adults who studied pictures were able to reduce their false alarms compared with those who studied words only. AD patients who studied pictures were unable to reduce their false alarms compared with those who studied words only and, in fact, exhibited trends toward greater false recognition. Implications for understanding semantic memory in AD patients are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender-related dissociations of categorical fluency in normal subjects and in subjects with Alzheimer's disease.

Semantic fluency tasks, with the categories of birds and furniture as stimuli, were administered to normal subjects and patients with Alzheimer's disease (AD). Normal subjects showed a gender-related double dissociation consistent with the literature data because men were more fluent with the birds category and women with the furniture category. Also, patients with AD showed a Gender × Category interaction, but the double dissociation between birds and furniture was not present because of a prevalent impairment of the living category birds that was irrespective of gender. This pattern of impairment in patients with AD was independent from the disease stage. The authors conclude that (a) gender-related categorical effects cannot be considered as inborn, sex-related cognitive differences but as familiarity effects and (b) both lesion-related and familiarity-related factors must be taken into account to explain category-specific effects of patients with brain damage and patients with AD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

WAIS-R Factor Structure in Alzheimer's Disease Patients: A Comparison of Alternative Models and an Assessment of Their Generalizability.

The WAIS-R is often used in neuropsychological evaluations of individuals with probable Alzheimer's disease (AD), but its factor structure in this population is unknown. Moreover, theories and past research findings make competing predictions concerning its structure. Using confirmatory factor analysis, the authors compared 5 alternative WAIS-R factor models among 516 AD patients: 1-factor (Spearman's g) and 2-factor (Verbal IQ and Performance IQ) models; a 3-factor model including Verbal Comprehension (VC), Perceptual Organization (PO), and Freedom From Distractibility (FD) factors; a 3-factor model in which Digit Symbol loads on PO rather than FD; and a 3-factor model in which Digit Symbol loads on both PO and FD. Results favored the 3-factor model in which Digit Symbol loads on PO rather than FD. Moreover, this model fit the data best among subsamples of patients defined by age, dementia severity, years of education, and gender. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in social support as mediators of the impact of a psychosocial intervention for spouse caregivers of persons with Alzheimer's disease.

The spouse caregivers of 406 patients with Alzheimer's disease were randomly assigned to an enhanced counseling and support intervention or to a usual care control condition. Structured interviews were conducted to assess changes in social support and psychosocial outcomes for the 312 caregivers who provided care in the home for at least 1 year. The number of support persons, satisfaction with the support network, and support persons' assistance with caregiving all increased significantly as a function of the intervention. Structural equation models indicated increased satisfaction with the social support network mediated a significant proportion of the intervention's impact on caregiver depression. A portion of this mediated effect was further mediated by changes in caregiver stress appraisals. Implications for strengthening intervention programs for spouse caregivers of individuals with Alzheimer's disease are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Semantic memory in Alzheimer's disease and the frontotemporal dementias: A longitudinal study of 236 patients.

Using semantic dementia (SD) as a reference point, the authors assessed semantic memory in four other neurodegenerative disorders: progressive nonfluent aphasia (PNFA), frontal variant frontotemporal dementia (fvFTD), Alzheimer's disease (AD), and posterior cortical atrophy (PCA). Individuals with SD were more impaired than other groups on semantic measures and showed a characteristic pattern across tasks: category fluency (CF) worse than letter fluency (LF), naming worse than comprehension, and visual and verbal comprehension equally affected, suggesting disruption to an amodal semantic system. Individuals with AD demonstrated a similar pattern to a milder degree. Although PNFA, fvFTD, and PCA groups had abnormal scores (relative to controls) on most semantic measures, their differing patterns across measures indicate that the apparent semantic impairment in these conditions is largely secondary to other factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Spatial attention and response control in healthy younger and older adults and individuals with Alzheimer's disease: Evidence for disproportionate selection impairments in the simon task.

The authors examined the degree to which aging and Alzheimer's disease (AD) influence the ability to control attention when conflict is presented in terms of incongruent mapping between a stimulus and the appropriate response. In a variant of the Simon task, healthy older adults and older adults with mild or very mild AD showed disproportionately larger reaction time (RT) costs when the stimulus and response were in conflict relative to RT costs of healthy younger adults. Analyses of RT distributions provide support for a 2-process model of the Simon effect in which there is a short-lived transient effect of the irrelevant dimension in younger adults and a more sustained influence across the RT distribution in older adults. An analysis of error rates showed that the older adults with mild and very mild AD made more errors on incongruent trials, suggesting that AD leads to increased likelihood of selecting the prepotent pathway. The findings are discussed in terms of the special nature of the response requirements of the Simon task to better illuminate the attentional decrements in both healthy aging and early stage AD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Narrative comprehension in Alzheimer's disease: Assessing inferences and memory operations with a think-aloud procedure.

Objective: To further understanding of text comprehension abilities in Alzheimer's disease (AD), a think-aloud protocol was used to examine the role of inferencing and the memory operations used to produce inferences. Method: Twenty participants with AD and 20 cognitively healthy older adults (OA) read narratives, pausing to talk aloud after each sentence. A verbal protocol analysis developed by Trabasso and Magliano (1996a) was used to code participants' utterances into inferential and noninferential clause types; inferential statements were then coded to identify the memory operation used in their generation. Results: Compared with OA controls, the AD participants showed poorer story comprehension, d = 2.0, produced fewer inferences, d = .67, and were less skilled at providing explanations of story events, d = 1.27, and in using prior text information to explain outcomes, d = .90. The AD group also appeared to rely more on the activation of world knowledge, d = .58, which contributed to less effective inferences and produced more incoherent noninferential statements, d = 1.05. Poorer text comprehension for the AD group was associated with poorer verbal memory abilities, r's > .55, and poorer use of prior text events when producing explanatory inferences, r = .42. Conclusions: The findings suggest that the memory difficulties of the AD group appear to be an important cognitive factor interfering with their ability to integrate story events through the use of inferences and to create a global coherence to support text comprehension. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Naming from definition, semantic relevance and feature type: The effects of aging and Alzheimer's disease.

Objective: The principal aim of the present study was to evaluate the impact of semantic relevance and feature type on the ability to name from definition. Method: Thirty-two normal young subjects (Study 1) and 20 probable Alzheimer's disease patients (pAD) with 20 matched older controls (Study 2) were tested with verbal definitions consisting of 4 features, combining feature type (sensory vs. nonsensory) and semantic relevance (high vs. low). The subjects were asked to provide a name corresponding to the definition and to select which individual features they considered most important in justifying their answer. Results: Feature selection results showed that high-relevance features first (d = 2.13 in Study 1; d = 1.44 in Study 2) and nonsensory features second (d = 0.81 in Study 1; d = 0.36 in Study 2) were the main dimensions driving correct performance. Overall, naming performance was affected by the age of acquisition (AoA) of the concept, and differences between the groups in all measures were mainly quantitative. Conclusions: These findings suggest that semantic relevance and feature type are important feature dimensions in conceptual representation and in conceptual access and retrieval. Moreover, results suggest that the former dimension may be more important than the latter, at least in the case of naming from definition. Finally, these results extend previous findings with other tasks, supporting the importance of AoA for correct performance and suggesting that the poorer performance of pAD patients on semantic tasks may represent an exaggeration of difficulties found also in normal older subjects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)