Depressed mood mediates decline in cognitive processing speed in caregivers

Clinically significant effects of group cognitive behavioral therapy on spouse caregivers' mental health and cognitive functioning: a pilot study

The objective of this pilot study was to investigate whether group cognitive behavioral therapy (CBT) resulted in clinically meaningful improvements in caregiver mood, burden, and cognition. We screened 97 caregivers in Toronto, Canada, of whom 25 with DSM-IV disorders began the 13-week CBT intervention, and 12 completed therapy and the 3-month follow-up. Each caregiver experienced clinically significant improvement on at least 2 of the following outcomes: diagnostic criteria, mood, attention, memory, and caregiver burden. Despite effectiveness, the challenges of recruiting distressed caregivers for therapy suggest that CBT might be most useful as part of a stepped care model of treatment.

Spouses of stroke survivors may be at risk for poor cognitive functioning: a cross-sectional population-based study

BACKGROUND

Stroke often results in chronic disability and the need for long-term assistance, which is provided in large part by spouses. Stroke caregivers experience poorer health and well-being compared with non-caregivers, but less is known about the specific toll that caregiving may exact on cognitive functioning.

OBJECTIVE

To investigate whether persons caring for a spouse who experienced a recent stroke may be at risk for poor cognitive functioning compared with non-caregivers.

METHODS

Existing data from the United States' Health and Retirement Study (HRS) were used to identify 146 caregivers from among couples in which 1 individual reported surviving a recent stroke and experiencing functional limitations. This cross-sectional population-based analysis compared the stroke caregivers with 3,416 non-caregivers in time orientation, working memory, semantic memory, learning, and episodic memory.

RESULTS

Overall, the caregiver group was considerably more disadvantaged than the non-caregiver group in terms of background characteristics, socioeconomic status, health, and well-being. Results of weighted Poisson regression models indicated that stroke caregivers were at risk for poorer performance than non-caregivers in working memory, semantic memory, learning, and episodic memory. The gap between stroke caregivers and non-caregivers in episodic memory remained after adjusting for systematic differences between the 2 groups across an array of risk factors.

CONCLUSIONS

Spousal caregivers of stroke survivors may be at risk for poor cognitive functioning. More work is needed to identify the processes that may contribute to the diminished cognitive capacity among these adults so that interventions may be developed to reduce caregiver burden and promote cognitive health.

Caregiver Burden in Fragile X Families

Complex caregiving issues occur in multigenerational families carrying the fragile X mutation and premutation. The same family members may care for children or siblings with fragile X syndrome (FXS) and for elderly parents with fragile X-associated tremor/ataxia syndrome (FXTAS). Family caregivers experience anxiety, depression, neglect of personal health care needs, employment difficulties, and loss of social support, leading to isolation and further psychiatric consequences. There is growing awareness of caregiver burden with regard to parents of children with FXS, but much less is known about the needs of informal caregivers of patients with FXTAS. In this paper, we review the available literature to date and provide suggestions for further exploration of caregivers' needs. Evidence-based strategies to address these needs are included. Many more research studies exploring caregiver burden in multigenerational fragile X families are needed, as well as studies aimed at investigating interventions and their impact on reduction.

Psychosocial and cognitive health differences by caregiver status among older Mexican Americans

This study identifies the risk and protective factors associated with informal caregiving by older (≥70 years) Mexican Americans and profiles caregiving arrangements. Overall, a greater number of informal caregivers (n = 92) were married and female. They also had higher physical functioning and better cognition than non-caregivers (n = 1,888) but fewer visited a physician regularly. Informal caregivers also showed an increased risk of depressive symptoms. A third of caregivers spent more than 20 h/day caregiving and the majority (84%) of care recipients were family members. In order to support the efforts of this disproportionately burdened caregiver group, increased social support and healthcare services are needed.

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.

Caregiving and cognitive function in older women: evidence for the healthy caregiver hypothesis

OBJECTIVES

Recent findings of better health outcomes in older caregivers than noncaregivers suggest a healthy caregiver hypothesis (HCH) model may be more appropriate than the stress process model for evaluating the health effects of caregiving. In a cross-sectional study, we tested the HCH on two cognitive domains: verbal memory and processing speed.

METHOD

Participants from the Caregiver Study of Osteoporotic Fractures who had a 2-year follow-up interview were categorized as continuous caregivers (n = 194), former caregivers (n = 148), or continuous noncaregivers (n = 574). The Hopkins Verbal Learning Test (HVLT; memory) and Digit Symbol Substitution Task (DSST; processing speed) were administered at the follow-up interview.

RESULTS

Continuous caregivers had better memory performance and processing speed than continuous noncaregivers: adjusted mean scores for HVLT were 18.38 versus 15.80 (p < .0001), and for DSST were 35.91 versus 34.38 (p = .09).

DISCUSSION

Results support the HCH model for cognitive outcomes in older women caregivers; however, the relationship may be domain specific.

Does caring for a spouse with dementia promote cognitive decline? A hypothesis and proposed mechanisms

OBJECTIVE

To discuss why spouse caregivers (CGs) of people with dementia may be at higher risk for cognitive problems and decline than demographically similar people not caring for a spouse with dementia (noncaregivers; NCGs).

DESIGN

Literature review.

SETTING

Community.

PARTICIPANTS

Older adults caring for a family member (primarily spouses) with dementia.

MEASUREMENTS

Cognitive, psychosocial, physiological, and behavioral.

RESULTS

This article reports a review of the literature examining relationships between CG status and cognitive problems in the context of a theoretical model of chronic stress. The model suggests that spouse CGs may be at higher risk of cognitive impairment or dementia than NCG spouses in response to several mediators, including psychosocial (e.g., depression, loneliness, social isolation, sleep problems), behavioral (e.g., exercise, diet), and physiological (e.g., metabolic syndrome and inflammation) variables.

CONCLUSION

This research has important implications because it considers modifiable risk factors for dementia that, if unchecked, may compromise the lives of CGs and their ability to function. It is hoped that an understanding of such stress-mediator-cognitive processes will help clinicians, researchers, policy-makers, and stakeholders mitigate what may be characterized as an "ironic tragedy"-dementia in both members of the caregiving dyad-if left unchecked.

Informal caregiving and self-reported mental and physical health: results from the Gazel Cohort Study

OBJECTIVES

We investigated whether, and under what conditions, informal caregiving is associated with improved self-reported physical and mental health, most notably in terms of cognitive functioning.

METHODS

We performed a cross-sectional analysis of 2008 data from the Gazel Cohort Study, which involved 10 687 men and women aged 54 to 70 years. Multivariate linear and logistic regression models were used to estimate the associations between self-reported health and caregiving status and burden.

RESULTS

Regular caregivers with the highest burden scores reported significantly worse health status than did noncaregivers for almost all of the physical and mental outcomes evaluated after adjustment for potential confounding factors. In particular, they reported more cognitive complaints (odds ratio [OR] = 1.44; 95% confidence interval [CI] = 1.21, 1.73). Conversely, caregivers with the lowest burden scores reported better perceived health status, less physical and mental tiredness, and fewer depressive symptoms (OR = 0.50; 95% CI = 0.37, 0.68) than did noncaregivers; however, they did not report decreases in cognitive difficulties (OR = 0.98; 95% CI = 0.81, 1.18).

CONCLUSIONS

Our findings support the hypothesis that caregiving can have positive effects on health, provided that caregiving activities themselves are not too heavy a burden.

Greater risk of dementia when spouse has dementia? The Cache County study

OBJECTIVES

To examine the effects of caring for a spouse with dementia on the caregiver's risk for incident dementia.

DESIGN

Population-based study of incident dementia in spouses of persons with dementia.

SETTING

Rural county in northern Utah.

PARTICIPANTS

Two thousand four hundred forty-two subjects (1,221 married couples) aged 65 and older.

MEASUREMENTS

Incident dementia was diagnosed in 255 subjects, with onset defined as age when subject met Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, criteria for dementia. Cox proportional hazards regression tested the effect of time-dependent exposure to dementia in one's spouse, adjusted for potential confounders.

RESULTS

A subject whose spouse experienced incident dementia onset had a six times greater risk for incident dementia as subjects whose spouses were dementia free (hazard rate ratio (HRR)=6.0, 95% confidence interval (CI)=2.2-16.2, P<.001). In sex-specific analyses, husbands had higher risks (HRR=11.9, 95% CI=1.7-85.5, P=.01) than wives (HRR=3.7, 95% CI=1.2-11.6, P=.03).

CONCLUSION

The chronic and often severe stress associated with dementia caregiving may exert substantial risk for the development of dementia in spouse caregivers. Additional (not mutually exclusive) explanations for findings are discussed.

Psychological health in older adult spousal caregivers of older adults

OBJECTIVES

The need for informal caregiving has been rapidly increasing across several countries. Spouses comprise a sizeable segment of informal caregivers and typically represent an older cohort with special health concerns. The objective of this review was to examine psychological health outcomes in older adult spouses caring for older adults.

METHODS

Literature review/synthesis (1999-2009).

RESULTS

Compared to demographically matched married non-caregiving controls, older adult spousal caregivers experienced more cognitive functioning difficulties, strain, distress, stress, loneliness, depression, anxiety and poorer mental health. Caregivers of spouses with cognitive impairments, quite often wives, were especially affected by poor psychological health, as were caregivers who were new to the caregiving role and those who rated caregiving as stressful. Psychological health improved when the caregiving role ceased.

DISCUSSION

Several poor psychological outcomes were found in older adults caring for their spouses; the magnitude of which varied and were more pronounced under certain circumstances. To preserve caregiver health, maintain recipient health and care quality and avoid exceeding system of care capacity, efforts are needed to provide support to older adult spousal caregivers and recipients. Couples may need to be assessed as a unit, taking gender and cultural considerations into account, and additional resources may be required.

Associations between psychological distress, learning, and memory in spouse caregivers of older adults

Family caregivers of older adults experience high levels of chronic stress and psychological distress, which are known to impair cognition. Very little research, however, has assessed the impact of caregiving on key cognitive outcomes such as learning and memory. This study compared 16 spouse caregivers with 16 matched controls using standardized neuropsychological measures of learning, episodic memory, and working memory. Analyses compared groups on these cognitive outcomes and examined whether psychological distress mediated group differences in cognition. Results indicated that caregivers were significantly more distressed than non-caregivers and exhibited deficits in learning, recall of episodic information after short and long delays, and working memory. Furthermore, the majority of group differences in cognitive outcomes were mediated by psychological distress. This study adds to a small body of literature demonstrating impaired cognitive functioning among family caregivers. It also suggests that distress is one of a number of possible underlying mechanisms leading to disruptions in learning and memory in this population.