Stress-related cognitive dysfunction in dementia caregivers

In a cross-sectional study, 31 dementia caregivers were compared to a group of 25 noncaregiving controls to evaluate whether the stress of being the primary caregiver of a person with dementia produces cognitive dysfunction. Cognitive differences were examined to evaluate the relationships between cognitive function and stress-related physiological and psychological measures to contribute information regarding its potential mechanism. The cognitive assessments were 2 measures of attention-executive function and 1 word list memory task. Physiological and self-rated stress-related measurements included cortisol, perceived stress, depression, self-efficacy, mindfulness, sleep quality, fatigue, and neuroticism. Caregivers performed worse than noncaregivers on the 2 attention tasks but not on the word list memory test. There was no interaction of caregiver status and age on cognitive performance. The caregivers and noncaregivers differed in morning salivary cortisol and most of the self-rated stress-related measures with the caregiver values reflecting greater stress. Of note, impaired sleep was the only potential mediator of the caregiver effect on cognitive performance in our small sample.     

The stress and psychological morbidity of the Alzheimer patient caregiver.

BACKGROUND: Alzheimer's family caregivers suffer from psychological and physical morbidity associated with the care of the Alzheimer's patient. The objectives of the study were to compare stress and psychological morbidity between family caregivers of Alzheimer's disease patients and family caregivers of aged non-demented chronically ill patients and to explore the impact of cognitive and non-cognitive patient symptoms on caregivers.METHOD: Fifty-eight caregivers of Alzheimer's patients (cases) and 32 caregivers of non-demented chronically ill patients (controls) were studied. A cross-sectional case-control design was employed using validated scales to assess patient symptomatology and self-report questionnaires to measure stress and psychological morbidity in caregivers.RESULTS: Compared to controls, stress and psychological morbidity were higher in caregivers of Alzheimer's patients. Behavioral symptoms and impairment in instrumental activities of daily living were associated with caregiver stress. Length of care was associated with caregiver psychological morbidity.CONCLUSIONS: Caregiver stress may be reduced with special attention paid to the treatment and management of behavioral and functional symptoms in the Alzheimer's disease patient. Caregiver education and coping skills should also be included.     

Factors related to cognitive reserve among caregivers of severe acquired brain injury

Stroke is one of the severe cause of motor and cognitive disabilities. These type of disabilities occurred a strong impact on whole family system. Caregiver burden may determine in relatives of patients with brain injury a decreasement of mental and physical health. The present study aims to better clarify the mechanism through which chronic stress influence caregivers’ cognitive functioning and how the psychological and cognitive resources may represent as a predictive factor. Caregivers were submitted to neuropsychological tests that evaluated level of mental health ad level of burden. Our results showed a significant correlation between cognitive reserve and self-efficacy skills in health care of patients. Findings suggested that the caregiver burden and the level of general distress influenced the cognitive performance. An improvement of cognitive functions is associated with a reduction of self-efficacy skills, causing a caregiver burden improvement.     

Cognitive and psychological predictors of everyday memory in children with intractable epilepsy

Children with epilepsy have known deficits on objective measures of learning and memory. Parents and children report that memory deficits have a negative impact on everyday functioning. In adults with epilepsy, self-report of memory is more strongly associated with depression than performance on memory tests. We investigated the cognitive and psychological predictors of everyday memory in 37 children with medically intractable epilepsy, using children's self-report and parent ratings of everyday memory performance and standard tests of attention, intelligence, visual and verbal memory, working memory, and mood/emotional state. Standard multiple regressions demonstrated that only a parent report measure of attention uniquely and significantly (P< or =0.05) predicted estimates of everyday memory performance, accounting for 33% of variance in children's own ratings and 27% of variance in parents' ratings. Findings suggest that everyday memory in children with intractable epilepsy differs from that of adults; attentional problems may underlie everyday memory problems in these children.     

Measuring and enhancing self-efficacy among professional caregivers of individuals with dementia

Nurses who provide care for individuals with Alzheimer's disease and other dementias are at risk of burnout. Self-efficacy is a psychological construct with the potential to help reduce or prevent the impact of caregiver stress. Evidence supporting a link between higher levels of self-efficacy and lower levels of stress is emerging among lay caregivers. However, concurrent research for professional caregivers lags behind, partly due to a lack of appropriate self-efficacy measures for this population. We developed an intervention to enhance self-efficacy and an inventory to measure its improvements among long-term care nurses. Training resulted in lasting improvements in knowledge and self-efficacy regarding the management of challenging team, resident, and family situations. Short-term reductions in caregiver burnout were also evident. Suggestions for maintaining improvements in caregiver burnout over longer periods are offered.     

The problem with "problem behaviors": a systematic review of the association between individual patient behavioral and psychological symptoms and caregiver depression and burden within the dementia patient-caregiver dyad

ABSTRACT Background: Behavioral and psychological symptoms of dementia (BPSDs) are routinely cited as important predictors of caregiver burden and depression. Although BPSDs include a wide variety of patient behaviors, they are routinely grouped together as one construct to differentiate them from cognitive symptoms of dementia. Determining the specific BPSDs that result in increased depression and burden for caregivers may elucidate the stress process for caregivers and facilitate the development of effective interventions for caregivers. Methods: We conducted a systematic review of English-language articles published from 1990 to 2010 to determine whether there are known symptoms or symptom clusters which exert undue negative impact on caregiver depression and burden. Additionally, we review systems used for classifying BSPD symptom clusters and determine whether there have been any mechanisms studied by which individual BPSD symptoms negatively affect caregivers. Finally, we examine how the role of timing of symptoms has been examined within the literature. Results: Thirty-five original research articles examined the impact of an individual behavior symptom on caregiver burden or depression/depressive symptoms. The studies had no consistent system for categorizing symptoms. Although depression, aggression, and sleep disturbances were the most frequently identified patient symptoms to impact negatively on caregivers, a wide range of symptoms was associated with caregiver burden and depression. Conclusions: The evidence is not conclusive as to whether some symptoms are more important than others. The studies reviewed were largely exploratory relative to the differential impact of individual BPSDs and did not focus on testing causal mechanisms by which specific symptoms exert more impact on caregiver mental health than others. Future research may benefit from the re-conceptualization of BPSDs from the perspective of their impact on the caregiver to examine hypothesis-driven differences among BPSD symptom clusters.     

Mild Cognitive Impairment and Caregiver Burden: A 3-Year-Longitudinal Study

ObjectivesMild cognitive impairment (MCI) is common, affecting 10%–35% of people over 65, and poses unique challenges for patients and their caregivers. Comparatively little research has examined caregiver burden in this population, with longitudinal research, in particular, lacking. We examined caregiver burden in a sample of people with MCI over 3 years.DesignThree-year observational study.SettingNine memory clinics in Australia.ParticipantsOne-hundred-and-eighty-five people with MCI and their caregivers.MeasurementsMeasures of caregiver burden, cognition, function, neuropsychiatric symptoms, driving status, and medication use were completed with patients and their caregivers at regular intervals over a 3-year period.ResultsBetween 21.1% and 29.5% of caregivers reported a clinically significant level of burden over the study. Patients’ higher levels of neuropsychiatric symptoms, lower functional ability, and lack of driving ability, and caregivers’ employment were associated with greater caregiver burden over time. Caregiver burden did not increase over time when controlling for patient and caregiver characteristics.ConclusionsHigh levels of caregiver burden are present in a significant proportion of caregivers of people with MCI. Clinical characteristics of patients – including severity of neuropsychiatric symptoms and functional impairment – and the employment status of caregivers predict burden. Such characteristics may help identify caregivers at greater risk of burden to target for intervention.     

Emotional memory deficit and its psychophysiological correlate in family caregivers of patients with dementia

This study examined the cortisol secretion pattern and declarative memory performance of dementia caregivers. An illustrated story paradigm memory task was used to evaluate the effects of emotional arousal on memory and assess the caregivers' cognitive compensation capacity. Younger (n=19) and elderly (n=24) noncaregivers and elderly caregivers (n=14) took part in 2 experiments to elucidate the effects of aging (experiment 1) and chronic stress (experiment 2) on memory performance and cortisol levels. Each group was divided in 2 subgroups: one that was exposed to an emotionally neutral story, and one that was exposed to a similar, but emotionally arousing story. Participants completed a multiple-choice questionnaire in the test session. Salivary cortisol samples were collected at 8:00 AM, 4:00 PM, and 10:00 PM, 1 day after memory testing. Experiment 1 showed that, despite an age-related memory deficit, arousal manipulation produced a similar effect in both age groups. Experiment 2 showed that, in addition to the characteristic memory decline of aging, elderly caregivers did not benefit from emotionally arousing material as their noncaregiver counterparts did. This impairment correlated with elevated nighttime cortisol levels, indicating a potential worsening impact of caregiver burden on age-related cognitive decline.     

Association between incongruence about survivor function and outcomes among stroke survivors and family caregivers

Background: Stroke survivors and family caregivers often have incongruent appraisals of survivor cognitive, physical, and psychosocial function. Partner incongruence contributes to poor outcomes for survivors and caregivers.

Objectives: This study explored whether partner incongruence: (1) differs by function domain; (2) increases or decreases over time, and; (3) is associated with self-rated health, distress, stress, and depressive symptoms.

Methods: Structured surveys were administered to 32 survivors and caregivers at approximately 3 (enrollment) and 7 months (follow-up) post-stroke. Paired t-tests were used to examine partners’ ratings of survivor function at enrollment and follow-up, and changes in incongruence over time. Partial correlations were used to examine the association between incongruence at enrollment and outcomes at follow-up.

Results: Survivors consistently rated their own memory and thinking as significantly better than caregivers rated their memory and thinking. At follow-up, survivors rated their own communication as significantly better than caregivers rated their communication. Incongruence about survivor memory and thinking was associated with survivor distress, as well as caregiver distress, stress, and depressive symptoms. Incongruence about survivor ADLs was associated with caregiver stress and depressive symptoms. Incongruence about survivor social participation was associated with caregiver distress.

Conclusions: Findings from this study suggest that survivors and caregivers often have incongruent appraisals of survivor function, that incongruence does not improve naturally over time, and that incongruence may be detrimental for survivor and caregiver outcomes. Further research should be directed at the mitigation of incongruence and strategies to improve outcomes for both survivors and family caregivers.     

The Comorbidity of ADHD and Bipolar Disorder: Any Less Confusion?

Alzheimer’s disease (AD) is the most common type of dementia and is a significant public health problem that will intensify as the population ages. The behavioral and psychological symptoms of dementia (BPSD) present a significant burden to patients, their families, and their caregivers. The majority of care is provided at home by family caregivers. Caring for a person with AD and other dementias is associated with significant risk to the caregiver’s health and well-being. Healthcare providers must recognize that family caregivers often present as secondary patients. Given the importance of these caregivers to patients with AD and other dementias, it is vital to understand the risk factors that impact caregiver health and well-being. Non-pharmacological interventions can reduce the negative impact of caregiver burden on caregiver health, reduce premature institutionalization of patients, and improve quality of life for patients, their families, and their caregivers. This article summarizes recent relevant research concerning AD and dementia caregiver health and psychosocial interventions.     

Caregiver needs and stress in caring for individuals with fetal alcohol spectrum disorder

ObjectiveIndividuals with FASD experience neurodevelopmental impairments and adverse outcomes, which can result in stress on the caregiver. However, there is little research on the needs of caregivers supporting individuals with FASD and whether they are associated with caregiver stress.Method125 caregivers of individuals with FASD completed a survey with questions adapted from the Family Caregiver Survey and the Perceived Stress Scale.ResultsCaregivers reported a range of needs and concerns, and high levels of stress. In many areas of caregiver well-being concerns tended to be higher among caregivers with adolescents and adults compared to those with children. Foster parents reported fewer well-being concerns than biological/kinship and adoptive parents. Caregivers who cared for the individuals for longer periods of time reported the most well-being concerns and lowest satisfaction with supports. Caregivers with the lowest income reported higher levels of stress than those with higher incomes. Higher reported stress was highly correlated with more needs/concerns.ConclusionsCaregivers of individuals with FASD have multiple areas of need and concern, and experience high levels of stress. Reducing demands on caregivers and providing resources may help reduce caregiver needs and stress, particularly for those caring for adolescents and adults, and those with lower incomes.     

Neuropsychological predictors of everyday memory and everyday functioning in patients with mild Alzheimer's disease

The contributions of executive function, naming, visuoperception, and delayed recall to everyday memory abilities and everyday living activities were examined in a sample (n = 24) of mildly impaired Alzheimer's disease (AD) patients. Everyday memory was rated independently by the patient and by a caregiver, and everyday functioning was rated by a caregiver. For patient-rated everyday memory, verbal recall accounted for 23% of the variance, while naming performance alone accounted for 56% of the variance in caregiver-rated everyday memory. Executive function was a unique and significant predictor of caregiver-rated functional daily living skills, accounting for 40% of the variance. Clinician's ratings of patient unawareness of deficit correlated with the discrepancy between caregiver and patient rating of memory. Caregiver reports of memory impairment appear to be influenced by naming abilities, indicating that language dysfunction may be misinterpreted as reflecting memory impairment. Helping caregivers distinguish between these two abilities may result in more accurate reporting of patients' impairments.     

Alzheimer caregiver stress: Basal natural killer cell activity, pituitary-adrenal cortical function, and sympathetic tone

The association between Alzheimer caregiving and natural killer (NK) cell activity and basal plasma levels of adrenocorticotropic hormone (ACTH), cortisol, β-endorphin, prolactin, epinephrine, norepinephrine, and neuropeptide Y was determined in 100 spousal Alzheimer caregivers and 33 age-and gender-comparable control volunteers upon intake into a study of the psychological and physiologic impact of caregiving. The relationship between these physiologic measures and individual characteristics such as age, gender, medical status, severity of stress, severity of depressive symptoms, and caregiver burden was tested. In addition, the association between NK activity and alterations of the neuroendocrine measures was investigated. As compared to controls, the Alzheimer caregivers had similar levels of NK activity and of basal plasma neuroendocrine hormones and sympathetic measures. While older age and male gender status were associated with increased levels of ACTH, neither medical caseness, severity of life stress, nor severity of depressive symptoms was associated with alterations in any of the multiple physiologic domains. Classification of Alzheimer caregiver burden identified caregivers who were mismatched in terms of the amount of care they were required to provide and the amount of respite time received. The mismatched caregivers had significantly higher basal plasma ACTH but no change in other physiological measures, as compared to non-mismatched caregivers. NK activity was negatively correlated with plasma levels of neuropeptide Y but not with any of the other neuroendocrine measures. Based on this cross-sectional evaluation of NK activity and neuroendocrine and sympathetic measures, we conclude that most Alzheimer caregivers do not show evidence of altered basal physiology.     

No effects of a combination of caregivers support group and memory training/music therapy in dementia patients from a memory clinic population

OBJECTIVES: To evaluate the impact of a combination of caregiver support group and memory training/music therapy in dementia patients on behavioural and psychological symptoms (BPSD) and caregiver burden compared to a control group. METHOD: Eighteen patient-carer-dyads in the treatment group and 18 patient-carer-dyads as controls were studied in the setting of a memory clinic of a psychiatric university hospital over a period of 2 years. Controls were matched for age, gender, diagnosis, dementia severity, living arrangement and medication. The interventions were conducted once per week for 1 hour run by a clinical psychogeriatric team. Outcome measures were patients' cognitive and functional status as well as BPSD and caregivers subjective burden and depression measured by validated scales. Data were obtained 6, 12 and 24 months after baseline. RESULTS: There were no significant differences between the intervention and control group neither after 6, 12 nor after 24 months treatment. CONCLUSIONS: The lack of a positive impact in alleviating caregiver burden or BPSD after intensive psychological interventions may result from extensive care in the routine clinical management including individual counselling for patients and families. The effect of 'treatment as usual' needs to be taken into account when comparing an intervention and control group, as well as the dosage of the intervention.     

Psychological well-being over time among informal caregivers caring for persons with dementia living at home

Objectives: To investigate informal caregivers’ psychological well-being and predicted increase in psychological well-being, when caring for persons with dementia (PwDs) living at home, related to caregiver, PwD and formal care (FC) factors.

Method: A cohort study at baseline and 3 months’ follow-up in eight European countries. Caregivers included (n = 1223) were caring for PwDs aged ≥ 65 years at home. Data on caregivers, PwDs and FC were collected using standardized instruments. Regression analysis of factors associated with caregiver psychological well-being at baseline and 3 months later was performed.

Results: Factors associated with caregiver psychological well-being at baseline were positive experience of caregiving, low caregiver burden, high quality of life (QoL) for caregivers, male gender of PwD, high QoL of PwD, few neuropsychiatric symptoms and depressive symptoms for the PwD. At follow-up, caregivers with increased psychological well-being experienced of quality of care (QoC) higher and were more often using dementia specific service. Predicting factors for caregivers’ increased psychological well-being were less caregiver burden, positive experience of caregiving, less supervision of the PwD and higher caregiver QoL, if PwD were male, had higher QoL and less neuropsychiatric symptoms. Furthermore, higher QoC predicted increased caregivers’ psychological well-being.

Conclusion: Informal caregiving for PwDs living at home is a complex task. Our study shows that caregivers’ psychological well-being was associated with, among other things, less caregiver burden and higher QoL. Professionals should be aware of PwD neuropsychiatric symptoms that might affect caregivers’ psychological well-being, and provide proper care and treatment for caregivers and PwDs.     

Caring for an individual with mild cognitive impairment: a qualitative perspective of health-related quality of life from caregivers

ABSTRACT

Objectives: Little is known regarding the effect that caring for an individual with Mild Cognitive Impairment (MCI) has on health-related quality of life (HRQOL). We sought to identify the most important aspects of HRQOL related to caring for an individual with MCI.

Methods: Six focus groups were conducted with caregivers of individuals with MCI (n = 32). Qualitative frequency analysis was used to analyze the data.

Results: Findings indicated that caregivers most frequently discussed social health, including changes in social roles and an increased need for social support (51.2% of the total discussion). This was followed by mental health concerns (37.9%) centering on anger/frustration, and a need for patience in the caregiving role, as well as caregiver-specific anxiety. Other topics included physical health (10.0%; including the impact that stress and burden have on medical heath), and caregivers’ cognitive health (0.9%; including memory problems in relation to caregiver strain, sleep disruption, and cognitive fatigue).

Conclusions: Findings illustrate the multiple domains of HRQOL that are affected in individuals providing care for someone with MCI. Moreover, the findings highlight the need for extending support services to MCI caregivers, a group that is typically not offered support services due to the ‘less severe’ nature of an MCI diagnosis.     

Coping strategies, anxiety and depression in caregivers of people with Alzheimer's disease

OBJECTIVES: There have been few longitudinal studies investigating the impact of coping on psychological morbidity in caregivers of people with dementia. Findings have been inconsistent and little attention has been paid to anxiety in caregivers. We explored the hypothesis that the relationship between caregiver burden and anxiety and depression is mediated by coping style. METHODS: As part of the LASER-AD study, 93 (73.8%) people with Alzheimer's disease and their family caregivers recruited at baseline were re-interviewed 1 year later. Sampling aimed to ensure that the participants were representative of people living in the UK with Alzheimer's disease in terms of dementia severity, gender and care setting. We used the Hospital Anxiety and Depression Scale, the Zarit Burden scale and the Brief COPE to measure coping strategies. RESULTS: Using fewer emotion-focused strategies and more problem-focused strategies (but not dysfunctional strategies) mediated the relationship between caregiver burden and anxiety a year later, after controlling for potential confounders, in a well-fitting structural equation model (chi(2) = 0.93, df = 3, p = 0.82; NFI = 1.0, RFI = 0.97, IFI = 1.0, TLI = 1.1, RMSEA = 0.0). Using fewer emotion focused strategies also predicted higher psychological morbidity in general. The hypothesised relationship was not proved for depression. CONCLUSIONS: Using emotion-focussed coping strategies in response to caregiver burden seemed to protect caregivers from developing higher anxiety levels a year later; however using problem-focussed strategies did not. Our results suggest that a psychological intervention package to emphasise emotion-focused coping may be a rational approach to reduce anxiety in dementia caregivers. Studies are needed to test such interventions. Copyright (c) 2008 John Wiley & Sons, Ltd.     

Co-occurring intellectual disability and autism: Associations with stress,coping, time use,and quality of life in caregivers

BackgroundHaving a child on the autism spectrum (AS) is known to impact caregiver quality of life (QoL), time use, and stress. A co-occurring diagnosis of intellectual disability (ID) is common among children on the autism spectrum, with ID itself impacting caregiver outcomes.MethodThis study sought to understand how co-occurring ID in children on the autism spectrum may influence caregiver-related outcomes. Secondary analysis of survey data from caregivers of 278 children on the autism spectrum with (n = 62) and without (n = 216) co-occurring ID was conducted, exploring impacts on caregiver QoL, stress, coping, and time-use.ResultsUnivariate analysis showed that caregivers of children on the autism spectrum with co-occurring ID reported greater levels of stress due to core symptoms and co-occurring physical conditions, and had different time use patterns then caregivers of children on the autism spectrum without co-occurring ID. Multivariate analysis, however, showed that caregivers of children on the autism spectrum with and without co-occurring ID differed only in the time they spent preparing meals, socialising with friends and accessing in-home respite care.ConclusionsThe presence of co-occurring ID in children on the autism spectrum had limited impacts on caregiver-related outcomes. Families of children across the entire AS require adequate supports.     

Anxiety and depression in family caregivers of people with Alzheimer disease: the LASER-AD study.

OBJECTIVE: There are high rates of stress, distress, and psychological illness in family caregivers of people with dementia. Female caregivers and those caring for people with neuropsychiatric symptoms are particularly at risk. The authors report on the prevalence of anxiety and depression in a sample of family caregivers of people with Alzheimer disease (AD) and compare the characteristics of those who did or did not have those conditions. METHODS: A group of 153 people with AD and their caregivers were interviewed as part of a larger study of AD. RESULTS: In all, 23.5% of caregivers scored at or above caseness level for anxiety, and 10.5%, at levels for depression. Care-recipient (CR) activities of daily living (ADL) impairment, being a caregiver living with the CR, being a female caregiver, reporting a poorer quality of relationship with the CR, and caregivers reporting their health as being poor all predicted anxiety disorder. CR irritability, caregivers reporting poor health, and a poorer quality of relationship with the CR predicted depression. CONCLUSIONS: Clinicians should be aware of the high rates of anxiety as well as depressive symptoms in family caregivers of people with AD, especially in female caregivers. CRs and Caregivers' impaired physical health put them at risk for psychological morbidity and should be treated energetically. A poor-quality relationship between the caregiver and the CR predicts both caregiver depression and anxiety. Caregivers living with the CR are much more likely to be anxious than depressed.