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Lee S, Chung JH. The relationship between dementia caregivers and quality of life in South Korean populations. Medicine (Baltimore) 2024; 103:e38605. [PMID: 38905432 PMCID: PMC11191904 DOI: 10.1097/md.0000000000038605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 05/24/2024] [Indexed: 06/23/2024] Open
Abstract
The purpose of this study was to assess the relationship between quality of life and dementia caregivers. The 2019 Korean Community Health Survey participants were assessed using the Patient Health Questionnaire-9, subjective cognitive decline (SCD) and SCD-related functional limitation, and EuroQol 5-dimension (EQ-5D). Sociodemographic and psychosocial variables were evaluated and compared between participants with dementia caregivers (n = 37,614) and non-dementia caregivers (n = 140,518). The dementia caregivers group reported significantly higher rates of depression, SCD, SCD-related functional restriction, and mean EQ-5D compared to the non-dementia caregivers group (P < .001). After adjusting for multiple confoundings, the odds ratio (OR) for depression (Patient Health Questionnaire-9 ≥ 10), SCD, SCD-related functional limitation, and lowest quartile of the EQ-5D index scores in the dementia caregivers group were 1.43 (95% confidence interval [CI], 1.29-1.59), 1.30 (95% CI: 1.24-1.36), 1.26 (95% CI: 1.20-1.32), and 1.22 (95% CI: 1.16-1.29), respectively. Physical activity (OR: 1.47; 95% CI: 1.43-1.52), self-control (OR: 1.41; 95% CI: 1.35-1.47), daily activity (OR: 1.55; 95% CI: 1.50-1.60), pain (OR: 1.62; 95% CI: 1.58-1.67), and anxiety/depression (OR: 2.17; 95% CI: 2.10-2.24) were all more common among participants in the dementia caregivers group than in the non-dementia family caregivers group. Depression, SCD, and a lower quality of life are linked to dementia caregivers, especially if there is moderate to severe anxiety or depression.
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Affiliation(s)
- Sujin Lee
- Department of Neurology, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea
| | - Jae Ho Chung
- Internal Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea
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Mroz EL, Schwartz AE, Valeika S, Oettingen G, Marottoli R, David D, Hagaman A, Fedus D, Monin JK. "WOOP is my safe haven": A qualitative feasibility and acceptability study of the Wish Outcome Obstacle Plan (WOOP) intervention for spouses of people living with early-stage dementia. Int J Geriatr Psychiatry 2024; 39:e6092. [PMID: 38687142 DOI: 10.1002/gps.6092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 04/15/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVES As symptoms emerge and worsen in people living with dementia, their spouses can benefit from behavioral interventions to support their adjustment as a care partner. The Wish Outcome Obstacle Plan (WOOP) intervention improves the well-being of spouses of people living with dementia early in the disease course, but intervention mechanisms and opportunities for improvement are unclear. The present study gave voice to spouses who participated in a trial of WOOP, describing how WOOP was incorporated into their lives and how it could be improved for future implementation. METHOD For this qualitative study, we conducted longitudinal semi-structured interviews among 21 spouses of people living with dementia (three interviews over three months; 63 interviews total). Codebook thematic analysis was performed. RESULTS Three meta-themes were derived: (1) assessing baseline strengths and limitations of WOOP, (2) learning from experience, and (3) fine-tuning and sustaining WOOP. Participants described how WOOP addressed their interpersonal and emotional stressors, their responses to behaviors of the person living with dementia, and their relationship quality. Considerations for future intervention delivery (e.g., solo vs. in group settings) and instructions (e.g., encouraging writing vs. thinking through the four steps of WOOP) were identified as areas of improvement. CONCLUSIONS WOOP was described as a practical, feasible, and desirable intervention for spouses at the early stages of their partner's dementia. Participants made WOOP easier to incorporate in their everyday lives by adapting the design into a mental exercise that they used as needed. Suggestions from participants specified how to make the everyday use of WOOP more feasible, sustainable, and applicable in a variety of contexts. TRIAL REGISTRATION ClinicalTrials.gov HIC 2000021852.
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Affiliation(s)
- Emily L Mroz
- Department of Geriatrics, Yale School of Medicine, New Have, Connecticut, USA
| | - Anna E Schwartz
- Social and Behavioral Sciences, Yale School of Public Health, New Have, Connecticut, USA
| | - Sarah Valeika
- Social and Behavioral Sciences, Yale School of Public Health, New Have, Connecticut, USA
| | - Gabriele Oettingen
- Department of Psychology, New York University, New York, New York, USA
- Department of Political and Social Sciences, Zeppelin University Friedrichshafen, Friedrichshafen, Germany
| | - Richard Marottoli
- Department of Geriatrics, Yale School of Medicine, New Have, Connecticut, USA
| | - Daniel David
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Ashley Hagaman
- Social and Behavioral Sciences, Yale School of Public Health, New Have, Connecticut, USA
| | - Donna Fedus
- Borrow My Glasses, Madison, Connecticut, USA
| | - Joan K Monin
- Social and Behavioral Sciences, Yale School of Public Health, New Have, Connecticut, USA
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Meng H, Lv X, Zhang R, Feng Y, Wang J, Liu J, Zhang J. Occurrence and Risk Factors for Cognitive Decline Shared by Couples: A Systematic Review and Meta-Analysis. J Alzheimers Dis 2024; 100:29-40. [PMID: 38848191 DOI: 10.3233/jad-240325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
Background To date, the magnitude of association and the quality of evidence for cognitive decline (mild cognitive impairment, Alzheimer's disease, and dementia) in couples and risk factors for outcomes have not been reviewed and analyzed systematically. Objective The aim of this study was to investigate the concordance of cognitive impairment in unrelated spouses and to qualitatively describe potential risk factors. Methods Eight databases were searched from inception to October 20, 2023. Eligible studies were independently screened and assessed for quality. Statistical analysis was conducted using Stata 15.1 software. The study was preregistered with PROSPERO (CRD42023488024). Results Eleven studies involving couples were included, with moderate to high evidence quality. Compared to controls, spouses of individuals with cognitive impairment had lower cognitive scores (Cohen's d: 0.18-0.62) and higher risk of cognitive decline (OR = 1.42, 95% CI: 1.15-1.76). The consistency of cognitive impairment between spouses was attributed to three theories: 1) the impact of caregiving stress experienced by the spouse; 2) assortative mating, which suggests that individuals select partners with similar characteristics; and 3) the influence of shared living environments and lifestyles. Conclusions The cognitive status of one spouse can affect the cognitive function of the other spouse. It is important to consider shared lifestyle, environmental, and psychobehavioral factors, as they may contribute to the risk of cognitive decline by couples. Identifying these factors can inform the development of targeted recommendations for interventions and preventive measures.
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Affiliation(s)
- Hongyan Meng
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Xiangru Lv
- Gansu Health Vocational College, Lanzhou, Gansu, China
| | - Rong Zhang
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Yuping Feng
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Jing Wang
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Jiarui Liu
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Juxia Zhang
- Clinical Educational Department, Gansu Provincial Hospital, Lanzhou, Gansu, China
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Su Q. Impact of Caregiving on Cognitive Functioning: Evidence From the China Health and Retirement Longitudinal Study. J Gerontol B Psychol Sci Soc Sci 2023; 78:1796-1804. [PMID: 37329275 DOI: 10.1093/geronb/gbad090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Indexed: 06/19/2023] Open
Abstract
OBJECTIVES Few studies have examined the association between caregiving and the cognitive functioning of caregivers. This study explored the association between caring for family members and cognition and how the link differs by caregiving intensity and caregiving types. Furthermore, rural-urban and gender heterogeneity were investigated. METHODS This study analyzed Waves 2011, 2013, and 2018 of the China Health and Retirement Longitudinal Study, with cognitive functioning assessed in 3 dimensions: memory, executive function, and orientation function. The cognition trajectories between caregivers and noncaregivers were compared with the growth curve model. RESULTS Results demonstrated a positive association between caregiving and cognitive functioning (β = 0.249, p < .001). Considering caregiving intensity, the positive association was only found in low (β = 0.335, p < .001) and moderate-intensity caregivers (β = 0.250, p < .05) but not in high-intensity caregivers. Moreover, grandparents, adult children, and multiple caregivers had a higher average cognition level at age 60 than noncaregivers (all β > 0, all p < .05), and adult child caregivers exhibited a significantly slower rate of decline in cognition across age (β = 0.040, p < .01). However, spousal caregivers showed no significant disparities with noncaregivers. Moreover, the impact of caregiving on memory function is more apparent among urban adults. DISCUSSION Results indicate that caregiving can benefit cognitive function. This study proposes considering caregiving intensity and caregiving types when exploring caregiving and cognition. Based on these findings, policy-makers may overcome the challenges involved in establishing and developing a supportive informal care system in China.
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Affiliation(s)
- Qing Su
- School of Public Health, Southeast University, Dingjiaqiao, Nanjing, China
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Elayoubi J, Nelson ME, Mu CX, Haley WE, Wadley VG, Clay OJ, Crowe M, Cushman M, Grant JS, Roth DL, Andel R. The role of caregiving in cognitive function and change: The REGARDS study. Psychol Aging 2023; 38:712-724. [PMID: 37428734 PMCID: PMC10776801 DOI: 10.1037/pag0000766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
Chronic stress is associated with negative health outcomes, including poorer cognition. Some studies found stress from caregiving associated with worse cognitive functioning; however, findings are mixed. The present study examined the relationship between caregiving, caregiving strain, and cognitive functioning. We identified participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study who were family caregivers at baseline assessment and used propensity matching on 14 sociodemographic and health variables to identify matched noncaregivers for comparison. Data included up to 14 years of repeated assessments of global cognitive functioning, learning and memory, and executive functioning. Our results showed that when compared to noncaregivers, caregivers had better baseline scores on global cognitive functioning and word list learning (WLL). Among caregivers, a lot of strain was associated with better WLL and delayed word recall in the unadjusted model only. Caregivers with a lot of strain had higher depressive symptoms but not significantly higher high-sensitivity c-reactive protein (hsCRP) at baseline compared to caregivers with no or some strain after covariate adjustment. Although caregiving can be highly stressful, we found caregiving status and caregiving strain were not associated with cognitive decline. More methodologically rigorous studies are needed, and conclusions that caregiving has negative effects on cognition should be viewed with caution. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Joanne Elayoubi
- School of Aging Studies, University of South Florida, Tampa, FL
| | | | - Christina X. Mu
- School of Aging Studies, University of South Florida, Tampa, FL
| | | | | | - Olivio J. Clay
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Michael Crowe
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mary Cushman
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT
| | - Joan S. Grant
- School of Nursing, University of Alabama at Birmingham, Birmingham
| | - David L. Roth
- Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University
| | - Ross Andel
- Center for Innovation in Healthy and Resilient Aging, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
- Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
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Krishnan S, Chen HT, Caston S, Rho S. Physical and Psychological Burden among Caregivers of Latinx Older Adults with Stroke and Multimorbidity. Ethn Dis 2023; 33:156-162. [PMID: 38854409 PMCID: PMC11155624 DOI: 10.18865/ed.33.4.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024] Open
Abstract
Objective To investigate the association between Latinx older adults' stroke, multimorbidity, and caregiver burden. Methods For this retrospective cohort study, we used the Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE) Wave-7 data set. The caregiver's physical burden was defined by using the Level of Burden Index. The caregiver's psychological burden was measured by using the Perceived Stress Scale (PSS-4). Multimorbidity was defined as the presence of 3 or more chronic conditions. Results The average age of the Latinx adults was 86 years, and the caregivers were 56 years. Latinx older adults and caregivers were more likely to be females (66% and 75%). Most caregivers were children (71%). Twelve percent of Latinx older adults presented with stroke, and 50% presented with multimorbidity. Caregiver physical burden was stratified into 3 levels: low (43%), medium (17%), and high (40%) burden. The cumulative logit model revealed that caregivers caring for those with stroke or multimorbidity had a high physical burden. Family caregivers and caregivers with a higher household income had a low physical burden. Caregivers with multimorbidity had a higher psychological burden. Caregivers who were interviewed in Spanish and those with higher household incomes had decreased psychological burden. Conclusion This study revealed that caregivers had a higher physical burden among caregivers of Latinx adults with stroke or multimorbidity. Future studies must investigate the relationship between Latinx adults' stroke and caregiver psychological health, and build culturally tailored policies and community interventions to support caregivers susceptible to high stress and burden.
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Affiliation(s)
- Shilpa Krishnan
- Division of Physical Therapy, Department of Rehabilitation Medicine, School of Medicine, Emory University, Atlanta, GA
| | - Haobin Tony Chen
- Department of Quantitative Theory and Methods, Emory College of Arts and Sciences, Atlanta, GA
| | - Sarah Caston
- Division of Physical Therapy, Department of Rehabilitation Medicine, School of Medicine, Emory University, Atlanta, GA
| | - Seunghwa Rho
- Department of Quantitative Theory and Methods, Emory College of Arts and Sciences, Atlanta, GA
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McCrae CS, Curtis AF, Stearns MA, Nair N, Golzy M, Shenker JI, Beversdorf DQ, Cottle A, Rowe MA. Development and Initial Evaluation of Web-Based Cognitive Behavioral Therapy for Insomnia in Rural Family Caregivers of People With Dementia (NiteCAPP): Mixed Methods Study. JMIR Aging 2023; 6:e45859. [PMID: 37616032 PMCID: PMC10485710 DOI: 10.2196/45859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 06/12/2023] [Accepted: 07/04/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Informal caregivers of people with dementia frequently experience chronic insomnia, contributing to stress and poor health outcomes. Rural caregivers are particularly vulnerable but have limited access to cognitive behavioral therapy for insomnia (CBT-I), a recommended frontline treatment for chronic insomnia. Web-based delivery promises to improve insomnia, particularly for rural caregivers who have limited access to traditional in-person treatments. Our team translated an efficacious 4-session standard CBT-I content protocol into digital format to create NiteCAPP. OBJECTIVE This study aimed to (1) adapt NiteCAPP for dementia caregivers to create NiteCAPP CARES, a tailored digital format with standard CBT-I content plus caregiver-focused modifications; (2) conduct usability testing and evaluate acceptability of NiteCAPP CARES' content and features; and (3) pilot-test the adapted intervention to evaluate feasibility and preliminary effects on sleep and related health outcomes. METHODS We followed Medical Research Council recommendations for evaluating complex medical interventions to explore user needs and adapt and validate content using a stepwise approach: (1) a rural dementia caregiver (n=5) and primary care provider (n=5) advisory panel gave feedback that was used to adapt NiteCAPP; (2) caregiver (n=5) and primary care provider (n=7) focus groups reviewed the newly adapted NiteCAPP CARES and provided feedback that guided further adaptations; and (3) NiteCAPP CARES was pilot-tested in caregivers (n=5) for feasibility and to establish preliminary effects. Self-report usability measures were collected following intervention. Before and after treatment, 14 daily electronic sleep diaries and questionnaires were collected to evaluate arousal, health, mood, burden, subjective cognition, and interpersonal processes. RESULTS The stepped approach provided user and expert feedback on satisfaction, usefulness, and content, resulting in a new digital CBT-I tailored for rural dementia caregivers: NiteCAPP CARES. The advisory panel recommended streamlining content, eliminating jargon, and including caregiver-focused content. Focus groups gave NiteCAPP CARES high usefulness ratings (mean score 4.4, SD 0.79, scored from 1=least to 5=most favorable; score range 4.2-4.8). Multiple features were evaluated positively, including the intervention's comprehensive and engaging information, caregiver focus, good layout, easy-to-access intervention material, and easy-to-understand sleep graphs. Suggestions for improvement included the provision of day and night viewing options, collapsible text, font size options, tabbed access to videos, and a glossary of terms. Pilot-test users rated usefulness (mean score 4.3, SD 0.83; range 4.1-4.5) and satisfaction (mean score 8.4, SD 1.41, scored from 1=least to 10=most satisfied; range 7.4-9.0) highly. Preliminary effects on caregiver sleep, arousal, health, mood, burden, cognition, and interpersonal processes (all P<.05) were promising. CONCLUSIONS Adaptations made to standard digital CBT-I created a feasible, tailored digital intervention for rural dementia caregivers. Important next steps include further examination of feasibility and efficacy in a randomized controlled trial with an active control condition, a multisite effectiveness trial, and eventual broad dissemination. TRIAL REGISTRATION ClinicalTrials.gov NCT04632628; https://clinicaltrials.gov/ct2/show/NCT04632628.
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Affiliation(s)
- Christina S McCrae
- Department of Psychiatry, University of Missouri, Columbia, MO, United States
- College of Nursing, University of South Florida, Tampa, FL, United States
| | - Ashley F Curtis
- College of Nursing, University of South Florida, Tampa, FL, United States
| | - Melanie A Stearns
- College of Nursing, University of South Florida, Tampa, FL, United States
| | - Neetu Nair
- Department of Psychiatry, University of Missouri, Columbia, MO, United States
| | - Mojgan Golzy
- Department of Family and Community Medicine, University of Missouri, Columbia, MO, United States
| | - Joel I Shenker
- Department of Neurology, University of Missouri, Columbia, MO, United States
| | - David Q Beversdorf
- Department of Neurology, University of Missouri, Columbia, MO, United States
- Departments of Radiology, University of Missouri, Columbia, MO, United States
- Department of Psychological Sciences, University of Missouri, Columbia, MO, United States
- The Thompson Center for Autism and Neurodevelopmental Disorders, University of Missouri, Columbia, MO, United States
| | | | - Meredeth A Rowe
- College of Nursing, University of South Florida, Tampa, FL, United States
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Miyawaki CE, Meyer OL, Chen NW, Markides KS. Health of Vietnamese Older Adults and Caregiver's Psychological Status in the United States: Result from the Vietnamese Aging and Care Survey. Clin Gerontol 2022; 45:1285-1293. [PMID: 32543347 PMCID: PMC9724209 DOI: 10.1080/07317115.2020.1764157] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: We examined the association between care recipient's physical, mental, and cognitive health conditions and caregivers' psychological distress in Vietnamese older care recipients and their caregivers.Methods: The Vietnamese Aging and Care Survey was developed for care recipients, and adult-child and spousal caregivers, and inquired about their sociodemographics and health-related variables.Results: Data were collected on 58 caregiver-care recipient dyads. Adult-child and spousal caregivers were on average 43 and 70 years-old respectively. The vast majority were female (76%) and born in Vietnam (97%). Adult-child caregivers reported more caregiver burden than spousal caregivers. Care recipients were on average 75 years-old. Care recipients of adult-child caregivers reported more depressive symptoms than care recipients of spousal caregivers and were more likely to have mild dementia. Care recipients' health had no effect on caregiver depressive symptoms but their educational attainment was associated with caregiver burden and depressive symptoms.Conclusions: This study showed care recipients and caregivers' years of education were positively associated with caregivers' psychological distress. Vietnamese families lived in ethnic enclaves and shared caregiving responsibilities within the family. However, using available outside resources may alleviate psychological distress of not only caregivers but also families as a whole.Clinical Implications: Healthcare professionals should encourage educated caregivers and educated care recipients to use outside resources to ease caregiving duties.
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Affiliation(s)
| | - Oanh L Meyer
- Department of Neurology, University of California, Davis School of Medicine, Sacramento, USA
| | - Nai-Wei Chen
- Beaumont Health, Beaumont Research Institute, Royal Oak, USA
| | - Kyriakos S Markides
- University of Texas Medical Branch, Preventive Medicine and Population Health, Galveston, USA
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McCrae CS, Curtis AF, Cottle A, Beversdorf DB, Shenker J, Mooney BP, Popescu M, Rantz M, Groer M, Stein P, Golzy M, Stearns MA, Simenson A, Nair N, Rowe MA. Impact of Web-Based Cognitive Behavioral Therapy for Insomnia on Stress, Health, Mood, Cognitive, Inflammatory, and Neurodegenerative Outcomes in Rural Dementia Caregivers: Protocol for the NiteCAPP CARES and NiteCAPP SHARES Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e37874. [PMID: 35700020 PMCID: PMC9240954 DOI: 10.2196/37874] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/11/2022] [Accepted: 04/26/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Chronic insomnia affects up to 63% of family dementia caregivers. Research suggests that chronic insomnia prompts changes in central stress processing that have downstream negative effects on health and mood, as well as on cognitive, inflammatory, and neurodegenerative functioning. We hypothesize that cognitive behavioral therapy for insomnia (CBT-I) will reverse those downstream effects by improving insomnia and restoring healthy central stress processing. Rural caregivers are particularly vulnerable, but they have limited access to CBT-I; therefore, we developed an accessible digital version using community input (NiteCAPP CARES). OBJECTIVE This trial will evaluate the acceptability, feasibility, and short-term and long-term effects of NiteCAPP CARES on the sleep and stress mechanisms underlying poor caregiver health and functioning. METHODS Dyads (n=100) consisting of caregivers with chronic insomnia and their coresiding persons with dementia will be recruited from Columbia and surrounding areas in Missouri, United States. Participant dyads will be randomized to 4 weeks (plus 4 bimonthly booster sessions) of NiteCAPP CARES or a web-based sleep hygiene control (NiteCAPP SHARES). Participants will be assessed at baseline, after treatment, and 6- and 12-month follow-ups. The following assessments will be completed by caregivers: 1 week of actigraphy and daily diaries measuring sleep, Insomnia Severity Index, arousal (heart rate variability), inflammation (blood-derived biomarkers: interleukin-6 and C-reactive protein), neurodegeneration (blood-derived biomarkers: plasma amyloid beta [Aβ40 and Aβ42], total tau, and phosphorylated tau [p-tau181 and p-tau217]), cognition (Joggle battery, NIH Toolbox for Assessment of Neurological and Behavioral Function, and Cognitive Failures Questionnaire), stress and burden, health, and mood (depression and anxiety). Persons with dementia will complete 1 week of actigraphy at each time point. RESULTS Recruitment procedures started in February 2022. All data are expected to be collected by 2026. Full trial results are planned to be published by 2027. Secondary analyses of baseline data will be subsequently published. CONCLUSIONS This randomized controlled trial tests NiteCAPP CARES, a web-based CBT-I for rural caregivers. The knowledge obtained will address not only what outcomes improve but also how and why they improve and for how long, which will help us to modify NiteCAPP CARES to optimize treatment potency and support future pragmatic testing and dissemination. TRIAL REGISTRATION ClinicalTrials.gov NCT04896775; https://clinicaltrials.gov/ct2/show/NCT04896775. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/37874.
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Affiliation(s)
| | | | | | | | - Joel Shenker
- University of Missouri, Columbia, MO, United States
| | | | | | | | - Maureen Groer
- University of South Florida, Tampa, FL, United States
| | | | - Mojgan Golzy
- University of Missouri, Columbia, MO, United States
| | | | | | - Neetu Nair
- University of Missouri, Columbia, MO, United States
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García-Castro FJ, Bendayan R, Dobson RJB, Blanca MJ. Cognition in informal caregivers: evidence from an English population study. Aging Ment Health 2022; 26:507-518. [PMID: 33719753 DOI: 10.1080/13607863.2021.1893270] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVES The relationship between caregiving and cognition remains unclear. We investigate this association comparing four cognitive tasks and exploring the role of potential explanatory pathways such as healthy behaviours (healthy caregiver hypothesis) and depression (stress process model). RESEARCH DESIGN AND METHODS Respondents were from English Longitudinal Study of Ageing (ELSA) (N = 8910). Cognitive tasks included immediate and delayed word recall, verbal fluency and serial 7 subtraction. Series of hierarchical linear regressions were performed. Adjustments included socio-demographics, health related variables, health behaviours and depression. RESULTS Being a caregiver was positively associated with immediate and delayed recall, verbal fluency but not with serial 7. For immediate and delayed recall, these associations were partially attenuated when adjusting for health behaviours, and depression. For verbal fluency, associations were partially attenuated when adjusting for depression but fully attenuated when adjusting for health behaviours. No associations were found for serial 7. DISCUSSION AND IMPLICATIONS Our findings show that caregivers have higher level of memory and executive function compared to non-caregivers. For memory, we found that although health behaviours and depression can have a role in this association, they do not fully explain it. However, health behaviours seem to have a clear role in the association with executive function. Public health and policy do not need to target specifically cognitive function but other areas as the promotion of healthy behaviours and psychological adjustment such as preventing depression and promoting physical activity in caregivers.
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Affiliation(s)
- F Javier García-Castro
- Department of Psychobiology and Behavioral Sciences Methodology, University of Malaga, Malaga, Spain
| | - Rebecca Bendayan
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR Biomedical Research Centre at South London and Maudsley, NHS Foundation Trust and King's College London, London, UK
| | - Richard J B Dobson
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR Biomedical Research Centre at South London and Maudsley, NHS Foundation Trust and King's College London, London, UK
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK London, University College London, London, UK
- NIHR Biomedical Research Centre at University College London Hospitals NHS Foundation Trust, London, UK
| | - María J Blanca
- Department of Psychobiology and Behavioral Sciences Methodology, University of Malaga, Malaga, Spain
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Wu-Chung EL, Leal SL, Denny BT, Cheng SL, Fagundes CP. Spousal caregiving, widowhood, and cognition: A systematic review and a biopsychosocial framework for understanding the relationship between interpersonal losses and dementia risk in older adulthood. Neurosci Biobehav Rev 2022; 134:104487. [PMID: 34971701 PMCID: PMC8925984 DOI: 10.1016/j.neubiorev.2021.12.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/23/2021] [Accepted: 12/06/2021] [Indexed: 01/18/2023]
Abstract
Accumulating research suggests that stressful life events, especially those that threaten close intimate bonds, are associated with an increased risk of dementia. Grieving the loss of a spouse, whether in the form of caregiving or after the death, ranks among 'life's most significant stressors', evoking intense psychological and physiological distress. Despite numerous studies reporting elevated dementia risk or poorer cognition among spousal caregivers and widow(er)s compared to controls, no review has summarized findings across cognitive outcomes (i.e., dementia incidence, cognitive impairment rates, cognitive performance) or proposed a theoretical model for understanding the links between partner loss and abnormal cognitive decline. The current systematic review summarizes findings across 64 empirical studies. Overall, both cross-sectional and longitudinal studies revealed an adverse association between partner loss and cognitive outcomes. In turn, we propose a biopsychosocial model of cognitive decline that explains how caregiving and bereavement may position some to develop cognitive impairment or Alzheimer's disease and related dementias. More longitudinal studies that focus on the biopsychosocial context of caregivers and widow(er)s are needed.
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Affiliation(s)
- E Lydia Wu-Chung
- Department of Psychological Sciences, Rice University, Houston, TX, United States.
| | - Stephanie L Leal
- Department of Psychological Sciences, Rice University, Houston, TX, United States
| | - Bryan T Denny
- Department of Psychological Sciences, Rice University, Houston, TX, United States
| | - Samantha L Cheng
- Department of Psychological Sciences, Rice University, Houston, TX, United States
| | - Christopher P Fagundes
- Department of Psychological Sciences, Rice University, Houston, TX, United States; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States; Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
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12
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Brewster GS, Molinari V, McCrae C, Beckstead J, D’Aoust R, Rowe M. Cognitive Function and Sleep in Caregivers of Persons Living with Dementia. West J Nurs Res 2022; 44:260-268. [PMID: 34467789 PMCID: PMC9112431 DOI: 10.1177/01939459211041163] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Poor sleep is prevalent among caregivers of persons living with dementia and increases their risk for cognitive impairment and decline. In this cross-sectional, correlational study, we compared the cognitive function scores of caregivers with poor sleep with the demographically adjusted normed scores of the National Institutes of Health Toolbox Cognition Battery. Caregivers completed a 14-day sleep diary. On average, caregivers (n = 28) were 65.14 (±10.08) years, female, and White. Their average crystallized cognitive function composite score was significantly higher and their average fluid cognitive function composite score was significantly lower than the normative scores. Caregivers performed significantly worse on the processing speed domain measure. Poor sleep may affect how caregivers, including highly educated caregivers, process and respond to information, thus can influence how they safely perform complex caregiving tasks. Health care providers should consistently assess caregivers' sleep and cognitive abilities to promptly identify changes and provide timely interventions.
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Affiliation(s)
- Glenna S. Brewster
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Victor Molinari
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | | | - Jason Beckstead
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Rita D’Aoust
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Meredeth Rowe
- College of Nursing, University of South Florida, Tampa, FL, USA
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13
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Wang HY, Ren L, Li T, Pu L, Huang X, Wang S, Song C, Liang Z. The impact of anxiety on the cognitive function of informal Parkinson's disease caregiver: Evidence from task-based and resting-state fNIRS. Front Psychiatry 2022; 13:960953. [PMID: 36159948 PMCID: PMC9492928 DOI: 10.3389/fpsyt.2022.960953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/18/2022] [Indexed: 11/16/2022] Open
Abstract
Informal Parkinson's disease (PD) caregivers are considered to experience high levels of caregiver burden, negatively affecting the health of caregivers. However, few studies explored the relationship between anxiety in caregiver burden and cognitive function in informal PD caregivers. Although, no study has even investigated the neural mechanisms underlying this connection. This study aimed to conduct comprehensive cognitive and clinical assessments and evaluate brain activity from task-based state and resting-state using functional near-infrared spectroscopy (fNIRS). A total of ten informal PD caregivers and 15 matched, healthy, non-caregivers were recruited. Comprehensive cognitive and clinical assessments were conducted to evaluate five cognitive domains and mental states. Neural activity induced by verbal fluency task (VFT) and brain connectivity during resting state were monitored, and their correlations with the neuropsychological and clinical tests were explored. Our results showed that compared to non-caregiver, an informal PD caregiver exhibited no difference in most cognitive domains of function but performed better in attentional function, along with higher levels of anxiety. Decreased activation over prefrontal regions during VFT and hypo-connectivity within the frontoparietal network (FPN) and between default mode network (DMN) and FPN in the resting state were confirmed in this study as a result of the negative effects of anxiety on the brain. Furthermore, Spearman's correlation found that neural activity in FPN during task-based state and resting state was negatively correlated with the severity of anxiety. These findings indicate that despite normal or even better cognitive function, informal PD caregivers have impaired brain function, and this deficit in neural activity was related to anxiety.
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Affiliation(s)
- Hai-Yang Wang
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lu Ren
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Tao Li
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lanlan Pu
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiaofeng Huang
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Song Wang
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Chunli Song
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zhanhua Liang
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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14
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Yang HW, Bae JB, Oh DJ, Moon DG, Lim E, Shin J, Kim BJ, Lee DW, Kim JL, Jhoo JH, Park JH, Lee JJ, Kwak KP, Lee SB, Moon SW, Ryu SH, Kim SG, Han JW, Kim KW. Exploration of Cognitive Outcomes and Risk Factors for Cognitive Decline Shared by Couples. JAMA Netw Open 2021; 4:e2139765. [PMID: 34928355 PMCID: PMC8689387 DOI: 10.1001/jamanetworkopen.2021.39765] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/20/2021] [Indexed: 11/14/2022] Open
Abstract
Importance Although couples could share many risk factors of cognitive disorders in their lifetime, whether shared risk factors mediate the shared risk of cognitive disorders has rarely been investigated. Objective To identify the risk factors of cognitive decline shared within couples and investigate their mediating roles in the shared risk of cognitive disorders and cognitive functions within couples. Design, Setting, and Participants A prospective cohort study was launched in November 1, 2010, and 784 participants were followed up every 2 years until December 31, 2020. This nationwide, multicenter, community-based study included older couples from the Korean Longitudinal Study on Cognitive Aging and Dementia (KLOSCAD) and a cohort of their spouses (KLOSCAD-S). Exposures The cognitive disorder of a spouse was defined as mild cognitive impairment or dementia. Main Outcomes and Measures The mediating roles of factors shared within couples on the association between one spouse's cognitive disorder and the other's risk of cognitive disorders was examined with structural equation modeling. Results Included were 784 KLOSCAD participants (307 women [39.2%] and 477 men [60.8%]; mean [SD] age, 74.8 [4.8] years) and their spouses (477 women [60.8%] and 307 men [39.2%]; mean [SD] age, 73.6 [6.2] years). The cognitive disorder of the KLOSCAD participants was associated with almost double the risk of cognitive disorder of their spouses in the KLOSCAD-S cohort (odds ratio, 1.74; 95% CI, 1.12-2.69; P = .01). History of head injury (β = 0.50; 95% CI, 0.09-0.90; P = .02) and age (β = 2.57; 95% CI, 1.37-3.76; P < .001) mediated the association between cognitive disorder in the KLOSCAD participants and their spouses' risk of cognitive disorder. Physical inactivity mediated the association through major depressive disorder (β = 0.33, 95% CI, 0.09-0.57, P = .006 for physical inactivity; β = 0.28, 95% CI, 0.13-0.44, P < .001 for major depressive disorder). These factors similarly mediated the association between spousal cognitive disorder and cognitive functions such as memory and executive function. Conclusions and Relevance These findings suggest that the risk factors shared within couples may mediate approximately three-quarters of the spousal risk of cognitive disorders. Identification of and intervention in the shared risk factors of dementia within couples may reduce the risk of cognitive disorders in the spouses of people with dementia.
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Affiliation(s)
- Hee Won Yang
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jong Bin Bae
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Psychiatry, Seoul National University, College of Medicine, Seoul, South Korea
| | - Dae Jong Oh
- Department of Psychiatry, Seoul National University, College of Medicine, Seoul, South Korea
- Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Dong Gyu Moon
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Eunji Lim
- Department of Psychiatry, Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Jin Shin
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Bong Jo Kim
- Department of Psychiatry, Gyeongsang National University, School of Medicine, Jinju, South Korea
| | - Dong Woo Lee
- Department of Neuropsychiatry, Inje University Sanggye Paik Hospital, Seoul, South Korea
| | - Jeong Lan Kim
- Department of Psychiatry, School of Medicine, Chungnam National University, Daejeon, South Korea
| | - Jin Hyeong Jhoo
- Department of Neuropsychiatry, Kangwon National University Hospital, Chuncheon, South Korea
| | - Joon Hyuk Park
- Department of Neuropsychiatry, Jeju National University Hospital, Jeju, South Korea
| | - Jung Jae Lee
- Department of Psychiatry, Dankook University Hospital, Cheonan, South Korea
| | - Kyung Phil Kwak
- Department of Psychiatry, Dongguk University Gyeongju Hospital, Gyeongju, South Korea
| | - Seok Bum Lee
- Department of Psychiatry, Dankook University Hospital, Cheonan, South Korea
| | - Seok Woo Moon
- Department of Psychiatry, School of Medicine, Konkuk University, Konkuk University Chungju Hospital, Chungju, South Korea
| | - Seung-Ho Ryu
- Department of Psychiatry, School of Medicine, Konkuk University, Konkuk University Medical Center, Seoul, South Korea
| | - Shin Gyeom Kim
- Department of Neuropsychiatry, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Psychiatry, Seoul National University, College of Medicine, Seoul, South Korea
| | - Ki Woong Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Psychiatry, Seoul National University, College of Medicine, Seoul, South Korea
- Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, South Korea
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15
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Secinti E, Lewson AB, Wu W, Kent EE, Mosher CE. Health-Related Quality of Life: A Comparative Analysis of Caregivers of People With Dementia, Cancer, COPD/Emphysema, and Diabetes and Noncaregivers, 2015-2018 BRFSS. Ann Behav Med 2021; 55:1130-1143. [PMID: 33761526 DOI: 10.1093/abm/kaab007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Many informal caregivers experience significant caregiving burden and report worsening health-related quality of life (HRQoL). Caregiver HRQoL may vary by disease context, but this has rarely been studied. PURPOSE Informed by the Model of Carer Stress and Burden, we compared HRQoL outcomes of prevalent groups of caregivers of people with chronic illness (i.e., dementia, cancer, chronic obstructive pulmonary disease [COPD]/emphysema, and diabetes) and noncaregivers and examined whether caregiving intensity (e.g., duration and hours) was associated with caregiver HRQoL. METHODS Using 2015-2018 Behavioral Risk Factor Surveillance System data, we identified caregivers of people with dementia (n = 4,513), cancer (n = 3,701), COPD/emphysema (n = 1,718), and diabetes (n = 2,504) and noncaregivers (n = 176,749). Regression analyses were used to compare groups. RESULTS Caregiver groups showed small, nonsignificant differences in HRQoL outcomes. Consistent with theory, all caregiver groups reported more mentally unhealthy days than noncaregivers (RRs = 1.29-1.61, ps < .001). Caregivers of people with cancer and COPD/emphysema reported more physically unhealthy days than noncaregivers (RRs = 1.17-1.24, ps < .01), and caregivers of people with diabetes reported a similar pattern (RR = 1.24, p = .01). However, general health and days of interference of poor health did not differ between caregivers and noncaregivers. Across caregiver groups, most caregiving intensity variables were unrelated to HRQoL outcomes; only greater caregiving hours were associated with more mentally unhealthy days (RR = 1.13, p < .001). CONCLUSIONS Results suggest that HRQoL decrements associated with caregiving do not vary substantially across chronic illness contexts and are largely unrelated to the perceived intensity of the caregiving. Findings support the development and implementation of strategies to optimize caregiver health across illness contexts.
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Affiliation(s)
- Ekin Secinti
- Department of Psychology, Indiana University-Purdue University Indianapolis, North Blackford Street, LD, Indianapolis, IN, USA
| | - Ashley B Lewson
- Department of Psychology, Indiana University-Purdue University Indianapolis, North Blackford Street, LD, Indianapolis, IN, USA
| | - Wei Wu
- Department of Psychology, Indiana University-Purdue University Indianapolis, North Blackford Street, LD, Indianapolis, IN, USA
| | - Erin E Kent
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Catherine E Mosher
- Department of Psychology, Indiana University-Purdue University Indianapolis, North Blackford Street, LD, Indianapolis, IN, USA
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16
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Madison AA, Kiecolt-Glaser JK. The gut microbiota and nervous system: Age-defined and age-defying. Semin Cell Dev Biol 2021; 116:98-107. [PMID: 33422403 PMCID: PMC8257779 DOI: 10.1016/j.semcdb.2020.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/01/2020] [Accepted: 12/21/2020] [Indexed: 02/07/2023]
Abstract
Even healthy older adults experience gastrointestinal (GI) and neurological changes. In fact, the aging process of these two systems are interrelated due the extensive, multifaceted communication network connecting them, termed the gut-brain axis. Age-related modification of the GI environment can influence the bacterial species that survive and thrive there. Additionally, the lifestyle common to older adults in the West, including sedentariness, polypharmacy, and a poor diet, can compound the effect of aging on the GI tract, gut microbiota, and nervous system. Emerging animal and human findings suggest that GI organisms play a major role in gut-brain communication, ultimately shaping neurological aging trajectories by either helping to maintain nervous system function into late life or promoting pathology. Aging and age-related behaviors help to define the gut microbiota's composition and function, but, conversely, the gut microbiota may help to determine late-life functionality and may be harnessed to limit the prevalence of steep neurological decline and diseases. Focusing primarily on clinical research, this review first defines the gut-brain axis, then details age-related GI and nervous system changes, and discusses the impact of age-related lifestyle factors on the GI and nervous systems. The remainder of this review describes cutting-edge research that positions the gut microbiota as an arbiter of age-related neurological decline.
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Affiliation(s)
- Annelise A Madison
- The Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, USA; Department of Psychology, The Ohio State University, USA
| | - Janice K Kiecolt-Glaser
- The Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, USA; Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, USA.
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17
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Terassi M, Ottaviani AC, Souza ÉND, Fraga FJ, Montoya P, Pavarini SCI, Hortense P. Cognition and chronic pain: an analysis on community-dwelling elderly caregivers and non-caregivers. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 79:201-208. [PMID: 33886793 DOI: 10.1590/0004-282x-anp-2019-0459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/01/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND In recent years there has been an increasing number of elderly people who care for another elderly person in the same household. These elderly people are more susceptible to overload and the presence of chronic pain, while pain can negatively influence cognitive variables. OBJECTIVE To compare the performance and cognitive processing of elderly caregivers and non-caregivers with and without chronic pain. METHODS This was a cross-sectional study carried out among 149 elderly people divided into four groups that were matched according to sex, age and schooling. The tests used were a numerical pain assessment scale, the Brief Cognitive Screening Battery (BCSB), Addenbrooke's Cognitive Examination (ACER-R) and cognitive processing through event-related potentials (P300). RESULTS Statistically significant differences between participants with and without chronic pain were found with regard to attention/orientation (p=0.045) and visual-spatial skills (p=0.017), and in the total score (p=0.033). In the pain-free group, the caregivers showed better results than the non-caregivers. There were no effects between subjects or interactions (caregiving and pain factors) either on P300 amplitude or on P300 latency. CONCLUSION In general, it was observed that pain-free individuals presented better performance. No relationship was observed between the factors care and pain regarding cognitive performance.
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Affiliation(s)
- Marielli Terassi
- Universidade Federal de São Carlos, Departamento de Enfermagem, São Carlos SP, Brazil
| | | | - Érica Nestor de Souza
- Universidade Federal de São Carlos, Departamento de Enfermagem, São Carlos SP, Brazil
| | - Francisco José Fraga
- Universidade Federal do ABC, Centro de Engenharia, Modelagem e Ciências Sociais Aplicadas, Santo André SP, Brazil
| | - Pedro Montoya
- University of Balearic Islands, Research Institute of Health Sciences, Palma, Spain
| | | | - Priscilla Hortense
- Universidade Federal de São Carlos, Departamento de Enfermagem, São Carlos SP, Brazil
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18
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Terassi M, Montoya P, Pavarini SCI, Hortense P. Influence of chronic pain on cognitive performance in elderly caregivers: a longitudinal study. Rev Bras Enferm 2021; 74:e20200412. [PMID: 34037192 DOI: 10.1590/0034-7167-2020-0412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 12/06/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to compare cognitive performance of elderly caregivers with and without chronic pain over four years and verify the effect of pain intensity on cognitive performance of elderly caregivers with chronic pain. METHOD a longitudinal study with data collected in 2014 and 2018. Community-dwelling elderly caregivers of a Brazilian city participated in the study. Cognition was assessed using the Addenbrooke's Cognitive Examination instrument. Pain was assessed by an 11-point scale. For data analysis, a mixed linear model and ANCOVA with a 5% significance level were used. RESULTS they were divided into two groups. A cognitive decline over four years was found in elderly people with pain (p=0.02; 95%CI=0.32-4.25), while those without pain did not show a significant change. CONCLUSION the results show that elderly caregivers with pain had a worse cognitive performance, but when comparing groups with the ANCOVA test for intergroup analysis, there was no difference in cognitive performance.
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Affiliation(s)
- Marielli Terassi
- Universidade Federal de São Carlos. São Carlos, São Paulo, Brazil
| | - Pedro Montoya
- Universitat de les Illes Balears. Palma de Mallorca, Spain
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19
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Falzarano F, Siedlecki KL. Differences in cognitive performance between informal caregivers and non-caregivers. NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2021; 28:284-307. [PMID: 32270735 PMCID: PMC7544647 DOI: 10.1080/13825585.2020.1749228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 03/24/2020] [Indexed: 10/24/2022]
Abstract
Extensive literature exists documenting the relationship between stress and cognition. Caregiving for an individual with Alzheimer's disease can be aunique and chronic stress experience due to the increasing dependency of the care-recipient as the disease progresses. The current study examines the relationship between stress and cognitive performance in 47 dementia caregivers compared to 47 noncaregiver control participants matched on age, gender, and education. Participants completed measures assessing stress (measured via the Perceived Stress Scale) and seven domains of cognition including episodic memory, working memory, executive functioning, attention, visuospatial processing, processing speed, and implicit memory. Results showed that caregivers had poorer performance than non-caregivers on certain measures of episodic memory, working memory, and executive functioning; while no significant differences were observed on measures of attention, visuospatial processing, processing speed, or implicit memory. In addition, when controlling for general stress, caregiver performance on measures of processing speed and visuospatial processing was also poorer than non-caregivers. By controlling for levels of general stress that may not be related to caregiving, these results show that differences in cognitive performance are unlikely to be explained by general stress alone.
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Affiliation(s)
| | - Karen L Siedlecki
- Department of Psychology, Fordham University , Bronx, NY, United States
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20
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Jütten LH, Mark RE, Sitskoorn MM. Episodic memory and executive functioning in informal dementia caregivers. Aging Ment Health 2020; 24:1681-1689. [PMID: 31116020 DOI: 10.1080/13607863.2019.1617242] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Objectives: Informal dementia caregivers are thought to experience high levels of depression and burden, which can contribute to worse cognitive functioning. However, poorer cognitive functioning in caregivers is not always found. The current study explored whether caregivers perform better, worse, or similar to non-caregivers on tasks for executive functioning and memory. Whether sociodemographic and psychosocial characteristics are associated with caregivers' performance was also assessed.Methods: One hundred forty-five caregivers completed the Letter Fluency and Category Fluency, the Logical Memory test from the WMS-III, and five questionnaires assessing psychological characteristics. Standardized z-scores (based on age, education, and sex) were calculated using data from a matched control group (187 non-caregivers). One sample z-tests were executed to examine if the caregivers' standardized mean z-score significantly deviated from the population mean of z = 0. The z-scores were used as dependent variables in multivariable regression analyses.Results: The caregivers performed significantly better on Logical Memory - Immediate Recall than non-caregivers (z = 2.92, p = .004). The obtained z-scores on the other tasks did not deviate significantly from 0. Male sex and social reliance predicted higher scores on Category Fluency, but the F-test was non-significant, and the explained variance was low (adjusted R2 = .068).Conclusions: We found no evidence for poorer cognitive performance among informal caregivers compared to non-caregivers. Our results suggest that caregiving for a loved one with dementia does not impair the caregivers' episodic memory or executive functioning when measured cross-sectionally.
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Affiliation(s)
- Linda Helena Jütten
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, The Netherlands
| | - Ruth Elaine Mark
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, The Netherlands
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21
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Romero-Martínez Á, Hidalgo-Moreno G, Moya-Albiol L. Neuropsychological consequences of chronic stress: the case of informal caregivers. Aging Ment Health 2020; 24:259-271. [PMID: 30450952 DOI: 10.1080/13607863.2018.1537360] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Introduction: Caring for a family member with a long-term illness is a significant source of chronic stress that might significantly accelerate the cognitive ageing of informal caregivers. Nevertheless, the absence of a defined theoretical body of literature on the neuropsychology of this population makes it difficult to understand what the characteristic neuropsychological deficits of these caregivers are.Aims: The main aim of this study is to carry out a systematic review of studies of cognitive deficits present in informal caregivers of people with several chronic pathologies, and analyse the effects of cognitive-behavioural interventions on caregivers' cognition.Methods: The scientific literature was reviewed following the PRISMA quality criteria for reviews using the following digital databases: PubMEd, PsycINFO, and Dialnet.Results: Identification of 2046 abstracts and retrieval of 211 full texts led to the inclusion of 38 papers. The studies showed heterogeneous results, but most of the cross-sectional studies reviewed that employed neuropsychological assessments concluded that informal caregivers reported a generalized cognitive deterioration, especially memory dysfunctions (i.e. learning verbal, visuospatial, and digit information). Moreover, they also presented low selective attention and capacity for inhibition, along with slow processing speed. Longitudinal studies confirmed that caregivers whose care situation was more prolonged showed a marked deterioration in their overall cognitive state, memory, processing speed, and vocabulary richness. However, although the patient's death does not seem to reverse the neuropsychological alterations in caregivers, cognitive-behavioural interventions that employ techniques to reduce stress levels, cognitive biases, and inadequate adaptation schemas seem to improve some of the aforementioned cognitive abilities.Conclusions: Results from this synthesis and critical analysis of neuropsychological deficits in informal caregivers offer guidelines for diagnosing caregivers' cognitive status by including a test battery covering all the domains considered relevant. Finally, given the ability of cognitive behavioural interventions to improve cognition in caregivers, further studies on their long-term effects on caregivers are warranted.Chronic stress entails an acceleration of the cognitive ageingCross-sectional studies concluded that informal caregivers reported a generalized cognitive deteriorationCognitive-behavioural interventions seem to improve cognitive abilities of caregivers.
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22
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O'Sullivan M, Brennan S, Lawlor BA, Hannigan C, Robertson IH, Pertl MM. Cognitive functioning among cognitively intact dementia caregivers compared to matched self-selected and population controls. Aging Ment Health 2019; 23:566-573. [PMID: 29381387 DOI: 10.1080/13607863.2018.1428937] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF THE STUDY Caregiving for a person with dementia is frequently used to model the impact of chronic stress on health, including cognitive functioning. However, the prevalence of typically healthier, self-selecting non-caregiving control groups could contribute to a picture of poorer caregiver performance and overstate the negative effects of stress. We investigated differences in cognitive performance between dementia caregivers and two groups of non-caregivers recruited using different sampling methods. DESIGN AND METHODS We compared cognitive function and psychological wellbeing among 252 spousal dementia caregivers with demographically matched non-caregiving control groups drawn from (1) a population study and (2) a self-selecting sample. Comparable cognitive measures included immediate and delayed recall, processing speed reaction time and verbal fluency. RESULTS Caregiver and non-caregiver performance was comparable on most cognitive domains. However, caregivers outperformed both control groups on processing speed (p ≤ .05) and reaction time (p ≤ .05), despite having higher levels of stress and depression (ps < .001). Furthermore, caregivers had significantly better free recall than self-selecting controls (p < .001). IMPLICATIONS Our results, overall, do not support the idea that caregiving is associated with stress-induced cognitive deficits. Rather, the trend toward better caregiver performance is consistent with the healthy caregiver hypothesis.
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Affiliation(s)
- Michael O'Sullivan
- a Neuro-Enhancement for Independent Lives (NEIL) Programme , School of Psychology , Trinity College Institute of Neuroscience (TCIN) , Trinity College Dublin , Dublin 2 , Ireland
| | - Sabina Brennan
- a Neuro-Enhancement for Independent Lives (NEIL) Programme , School of Psychology , Trinity College Institute of Neuroscience (TCIN) , Trinity College Dublin , Dublin 2 , Ireland
| | - Brian A Lawlor
- a Neuro-Enhancement for Independent Lives (NEIL) Programme , School of Psychology , Trinity College Institute of Neuroscience (TCIN) , Trinity College Dublin , Dublin 2 , Ireland
| | - Caoimhe Hannigan
- a Neuro-Enhancement for Independent Lives (NEIL) Programme , School of Psychology , Trinity College Institute of Neuroscience (TCIN) , Trinity College Dublin , Dublin 2 , Ireland
| | - Ian H Robertson
- a Neuro-Enhancement for Independent Lives (NEIL) Programme , School of Psychology , Trinity College Institute of Neuroscience (TCIN) , Trinity College Dublin , Dublin 2 , Ireland
| | - Maria M Pertl
- a Neuro-Enhancement for Independent Lives (NEIL) Programme , School of Psychology , Trinity College Institute of Neuroscience (TCIN) , Trinity College Dublin , Dublin 2 , Ireland.,b Department of Psychology , Royal College of Surgeons in Ireland , Dublin 2 , Ireland
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Peng HL, Lorenz RA, Chang YP. Factors associated with sleep in family caregivers of individuals with dementia. Perspect Psychiatr Care 2019; 55:95-102. [PMID: 29971795 DOI: 10.1111/ppc.12307] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 05/24/2018] [Accepted: 06/09/2018] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The study aimed to identify factors related to family caregivers' sleep. DESIGN AND METHODS The study used a cross-sectional design with objective and subjective methods to measure sleep in the home setting over a 7-day period. FINDINGS Findings indicated that poor sleep quality was found in 91.7% of the caregiver participants. Depression, sleep hygiene, burden, and care-recipients' sleep were significant predictors of various dimensions of caregivers' sleep. PRACTICE IMPLICATIONS Our study suggests that sleep quality for family caregivers of individuals with dementia varies considerably from night to night. Understanding the complex interrelationships among caregivers' sleep and other contributing variables is an important first step toward the development of individualized and effective treatment strategies.
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Affiliation(s)
- Hsi-Ling Peng
- Department of Nursing, Cardinal Tien Junior College of Healthcare and Management, New Taipei City, Taiwan
| | - Rebecca A Lorenz
- School of Nursing, The State University of New York, University at Buffalo, Buffalo, NY, USA
| | - Yu-Ping Chang
- School of Nursing, The State University of New York, University at Buffalo, Buffalo, NY, USA
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Ma M, Dorstyn D, Ward L, Prentice S. Alzheimers' disease and caregiving: a meta-analytic review comparing the mental health of primary carers to controls. Aging Ment Health 2018; 22:1395-1405. [PMID: 28871796 DOI: 10.1080/13607863.2017.1370689] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To quantitatively review the literature comparing depressed mood, anxiety and psychological distress in caregivers (CGs) of older adults with Alzheimer's disease (AD) with non-caregivers (NCGs) Methods: Eighteen independent studies comparing AD CGs (N = 2378) with NCGs (N = 70,035) were evaluated in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Standardised mean differences (Hedges' g) with associated 95% confidence intervals and p-values were calculated using a random-effects model. RESULTS Studies generally conformed to STROBE criteria in terms of their methodological and procedural detail, although data management issues that may contribute to methodological bias were identified. Pooled effect estimates revealed medium to large group differences in depression (gw = 1.01 [CI: 0.73, 1.29] p < 0.01) and anxiety (gw = 0.64 [CI: 0.39, 0.89] p < 0.01): AD caregivers reported higher symptom severity. Gender was a significant moderator: female caregivers experienced poor self-reported mood (gw = 1.58 [CI: 1.11, 2.05], p < 0.01), although this analysis was limited in power given the small number of contributing studies. DISCUSSION Caregivers of patients with AD experience poor mental health in comparison to the general population, with female caregivers being disproportionately affected. Further exploration of the psychosocial variables that contribute to these group differences is needed to inform effective support services and, in turn, help caregivers manage the emotional demands of AD.
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Affiliation(s)
- Mandy Ma
- a Faculty of Health and Medical Sciences, School of Psychology , University of Adelaide , Adelaide , Australia
| | - Diana Dorstyn
- a Faculty of Health and Medical Sciences, School of Psychology , University of Adelaide , Adelaide , Australia
| | - Lynn Ward
- a Faculty of Health and Medical Sciences, School of Psychology , University of Adelaide , Adelaide , Australia
| | - Shaun Prentice
- a Faculty of Health and Medical Sciences, School of Psychology , University of Adelaide , Adelaide , Australia
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Zwar L, König HH, Hajek A. The impact of different types of informal caregiving on cognitive functioning of older caregivers: Evidence from a longitudinal, population-based study in Germany. Soc Sci Med 2018; 214:12-19. [PMID: 30134218 DOI: 10.1016/j.socscimed.2018.07.048] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 07/09/2018] [Accepted: 07/27/2018] [Indexed: 12/23/2022]
Abstract
STUDY AIM This study's aim was to investigate the influence of different caregiving types on cognitive functioning of caregivers aged 65 years and older longitudinally and to look at potential gender differences in this association. METHOD Data from the German Ageing Survey, a longitudinal population-based study assessing community-dwelling people in Germany, was used. Our sample consisted of participants 65 years and older (waves 2008, 2011 and 2014; N = 6560). Informal caregiving was assessed in terms of three caregiving types (help around the house, looking after someone, performing nursing care services). An adaption of the widely used Digit Symbol Substitution Test was used to assess cognitive function. RESULTS Fixed-effects regressions demonstrated a positive association of looking after someone with cognitive functioning (β = 1.90, p < .01). There was no significant association of help around the house (β = 0.96, p = .22) or performing nursing care services (β = 2.12, p = .09) with cognitive function. Stratifying for gender, we found this effect of looking after someone on cognitive functioning only in women (β = 2.82, p < .01), but not in men (β = 1.00, p = .23). The other caregiving types showed no significant association with cognitive function, neither in men (helping around the house: β = 0.20, p = .85; performing nursing care services: β = 1.16, p = .52), nor in women (helping around the house: β = 1.67, p = .13; performing nursing care services: β = 2.88, p = .09). CONCLUSIONS Results indicate that informal caregiving, in terms of looking after someone, can be beneficial for cognitive function, at least for female caregivers. Thus, we recommend to consider caregiving types when investigating informal caregiving and cognitive function. Furthermore, we recommend to focus support more on other outcomes, particularly for female caregivers.
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Affiliation(s)
- Larissa Zwar
- University Medical Center Hamburg-Eppendorf, Department of Health Economics and Health Services Research, Martinistr. 52, 20246, Hamburg, Germany.
| | - Hans-Helmut König
- University Medical Center Hamburg-Eppendorf, Department of Health Economics and Health Services Research, Martinistr. 52, 20246, Hamburg, Germany.
| | - André Hajek
- University Medical Center Hamburg-Eppendorf, Department of Health Economics and Health Services Research, Martinistr. 52, 20246, Hamburg, Germany.
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Abstract
UNLABELLED ABSTRACTBackground:With a rise in the aging population and a consequential rise in persons diagnosed with dementia comes an increase in the number of informal caregivers who are caring for a loved one. The objective of the proposed study was to assess the neurocognitive and psychological effects of caring for a person with dementia or a related neurodegenerative disease in a sample of Canadian informal caregivers. METHODS Fifty-seven informal caregivers of a person with dementia or a related neurodegenerative disease (mean age = 66.26, SD = 7.55) and 97 non-caregivers (mean age = 69.16, SD = 4.84) were recruited. Neuropsychological measures of attention, cognitive flexibility, verbal learning, delayed recall, and verbal fluency were examined, and questionnaires related to perceived stress, quality of life, mood, and self-esteem were administered. RESULTS Caregivers made more errors on a measure of cognitive flexibility (p = 0.02), generated fewer words on measures of phonemic fluency (p < 0.01) and semantic fluency (p < 0.001), and learned significantly fewer words on a list-learning task (p < 0.01). Caregivers also reported experiencing significantly more perceived stress (p < 0.001), lower quality of life (p < 0.001), and were more likely to meet the cut-off for clinically significant depressive symptoms on a self-report scale (p < 0.001). CONCLUSION These data contribute to a growing body of literature that consistently points to the need for immediate action to improve the welfare of caregivers.
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Kurita K, Lachs MS, Adelman RD, Siegler EL, Reid MC, Prigerson HG. Mild cognitive dysfunction of caregivers and its association with care recipients' end-of-life plans and preferences. PLoS One 2018; 13:e0196147. [PMID: 29708996 PMCID: PMC5927428 DOI: 10.1371/journal.pone.0196147] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 04/07/2018] [Indexed: 12/04/2022] Open
Abstract
Little is known about the association between cognitive dysfunction among informal caregivers and patients’ plans and preferences for patients’ end of life care. We report on the frequency of cognitive dysfunction among both patients and caregivers and examine associations between caregivers’ cognitive screening scores and end of life plans and preferences of patients with advanced cancer. The current sample was derived from a National Cancer Institute- and National Institute of Mental Health-funded study of patients with distant metastasis who had disease progression on at least first-line chemotherapy, and their informal caregivers (n = 550 pairs). The Pfeiffer Short Portable Mental Status, a validated cognitive screen, was administered to patients and caregivers. Patients were interviewed about their end of life plans and preferences. Logistic regression models regressed patients’ advance care planning and treatment preferences on caregivers’ cognitive screen scores. Patients’ cognitive screen scores were included as covariates. Most caregivers (55%) were spouses. Almost 30% of patients scored worse on the cognitive screen than their caregivers and 12% of caregivers scored worse than the patients. For each additional error that caregivers made on the cognitive screen, patients were more likely (AOR = 1.59, p = 0.002) to report that they preferred that everything possible be done to keep them alive and were less likely (AOR = 0.75, p = 0.04) to have a living will or a health care proxy/durable power of attorney. Worse caregiver cognitive screening scores were associated with higher likelihood of patients’ reporting that they wanted everything done to save their lives and a lower likelihood of having a living will or other type of advanced care plan. Future studies should confirm these findings in other populations and determine the mechanisms that may underlie the identified relationships.
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Affiliation(s)
- Keiko Kurita
- Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York, United States of America
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Mark S. Lachs
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Ronald D. Adelman
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Eugenia L. Siegler
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - M. Cary Reid
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Holly G. Prigerson
- Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York, United States of America
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
- * E-mail:
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28
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Sneed RS, Schulz R. Grandparent Caregiving, Race, and Cognitive Functioning in a Population-Based Sample of Older Adults. J Aging Health 2017; 31:415-438. [PMID: 29254404 DOI: 10.1177/0898264317733362] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The aim of this study was to evaluate the association between noncustodial grandparent caregiving and cognition using the Health and Retirement Study (HRS), a population-based study of older adults. Method: Participants were White and African American grandparents aged ≥65 years. Only noncustodial grandparents who reported not living with their grandchildren over the three waves were included in our analyses. Grandparent caregiving status and cognition were assessed in 2006, 2008, and 2010. Analyses controlled for demographics, baseline health, depressive symptoms, and baseline cognition. Results: Both the number of waves of grandparent caregiving and the total number of grandparent caregiving hours across the three waves were associated with better cognitive functioning at 4-year follow-up in 2010. Associations were observed among Whites, but not among African Americans. Discussion: This study uses longitudinal data to evaluate the association between grandparent caregiving and cognitive functioning. Findings suggest that providing care may be beneficial for some grandparents.
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Affiliation(s)
- Rodlescia S Sneed
- University of Pittsburgh, PA, USA.,Michigan State University, Flint, USA
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Karantzas GC, Gillath O. Stress and wellbeing during chronic illness and partner death in later-life: the role of social support. Curr Opin Psychol 2017; 13:75-80. [PMID: 28813299 DOI: 10.1016/j.copsyc.2016.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 04/29/2016] [Accepted: 05/11/2016] [Indexed: 10/21/2022]
Abstract
Chronic illness and the death of a romantic partner are two of the most significant stressors reported by older adults, resulting in various physical and mental health consequences. Evidence suggests that social support is a key factor in understanding the association between chronic illness and widowhood and the wellbeing of older adults. Nevertheless, research into social support is often approached in an atheoretical manner when investigating these stressors in older adulthood. We attempt to address this theoretical chasm by proposing an integrative model to explain social support processes in older couples which draws on models of social support and attachment theory. Our model provides an important framework for understanding existing research findings as well as guiding future research.
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Affiliation(s)
- Gery C Karantzas
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia.
| | - Omri Gillath
- Department of Psychology, University of Kansas, 1415 Jayhawk Boulevard, Lawrence, KS 66045, USA
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30
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Merrilees J. The Impact of Dementia on Family Caregivers: What Is Research Teaching Us? Curr Neurol Neurosci Rep 2017; 16:88. [PMID: 27541750 DOI: 10.1007/s11910-016-0692-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Dementia family caregiving has been the focus of research for decades. Much has been learned about the negative impact of caregiving as well as characteristics that may be protective. This paper explores themes in caregiving pertinent to clinicians and researchers working with dementia family caregivers: the psychological, subjective, and physical outcomes of caregiving, ways in which dementia alters relationships between the patient and caregiver, and strategies for improving outcomes for caregivers. Suggestions for next steps in research and clinical care are made.
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Affiliation(s)
- Jennifer Merrilees
- UCSF Department of Neurology, Memory and Aging Center, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158-1207, USA.
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31
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Vitaliano PP, Ustundag O, Borson S. Objective and Subjective Cognitive Problems among Caregivers and Matched Non-caregivers. THE GERONTOLOGIST 2017; 57:637-647. [PMID: 26903233 PMCID: PMC5881794 DOI: 10.1093/geront/gnv690] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 10/27/2015] [Indexed: 11/14/2022] Open
Abstract
Purpose of the study Caregivers (CGs) have been shown to do more poorly than non-caregivers (NCGs) on objective cognitive tests (Trails B and Digit Symbol Test, DST), but less is known about whether these groups differ in: (a) reports of subjective cognitive problems (SCPs, memory complaints, etc.) and (b) relationships of SCPs with objective cognitive tests, depression, and stress exposure. Such relationships are important because researchers/clinicians use SCPs as proxies for objective cognitive tests. Design and methods One hundred and twenty-two spouse CGs of persons with Alzheimer's disease and 117 demographically matched NCG spouses were compared on Trails B and DST at baseline (T1), 1 year later (T2), and 2 years later (T3) and on SCPs at T1. Results Trails B was slower in CGs than NCGs and DST declined in CGs relative to NCGs. CGs reported more SCPs than NCGs. Depression mediated group differences in Trails and DST and was also associated with SCPs. Trails B and DST explained variance in SCPs in NCGs, but not in CGs. Hours of care explained variance in SCPs in CGs, but not in NCGs. Implications When using SCPs to make inferences about CG cognitive function, researchers/clinicians should consider the possible influence of stress exposures and depression. The lack of associations of objective and subjective cognitive measures may be a reflection of poorer self-monitoring among CGs, a potential new area of CG research.
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Affiliation(s)
- Peter P. Vitaliano
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
- Department of Psychology, University of Washington, Seattle
| | - Ozge Ustundag
- Department of Psychology, University of Washington, Seattle
| | - Soo Borson
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
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Moretta P, Masotta O, Crispino E, Castronovo G, Ruvolo S, Montalbano C, Loreto V, Trojano L, Estraneo A. Psychological distress is associated with altered cognitive functioning in family caregivers of patients with disorders of consciousness. Brain Inj 2017; 31:1088-1093. [PMID: 28414249 DOI: 10.1080/02699052.2017.1290278] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To analyse the possible presence of reduced cognitive efficiency in family caregivers of patients with prolonged disorders of consciousness (DOC). SUBJECTS The participants were 27 caregivers of 25 patients with DOC admitted to the severe brain injury units of the ICS Maugeri, Institutes of Telese Terme and Sciacca, Italy. METHODS We examined cognitive functions such as short- and long-term memory, executive functions and attention by means of standardized tests. We also assessed features of psychological distress such as anxiety, depression, psychophysiological symptoms, prolonged grief disorder, psychological burden and quality of life. All scores on neuropsychological tests were compared with those of the 15 matched control subjects. RESULTS Enrolled family caregivers showed high frequency of clinically relevant depressive symptoms and anxiety; half of them met the criteria for prolonged grief disorder. Caregivers achieved scores lower than the matched controls on tests for selective attention, verbal fluency and long-term spatial memory. CONCLUSIONS Family caregivers' burden is associated with a reduced efficiency of selected executive measures and visuospatial learning. These results emphasize the need for appropriate psychological and cognitive supporting therapies for family caregivers of patients with DOC, also considering their delicate involvement in clinical decision-making and in providing care.
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Affiliation(s)
- P Moretta
- a Disorders of Consciousness Laboratory, ICS Maugeri, IRCCS , Scientific Institute of Telese Terme , Telese Terme , Italy
| | - O Masotta
- a Disorders of Consciousness Laboratory, ICS Maugeri, IRCCS , Scientific Institute of Telese Terme , Telese Terme , Italy
| | - E Crispino
- a Disorders of Consciousness Laboratory, ICS Maugeri, IRCCS , Scientific Institute of Telese Terme , Telese Terme , Italy
| | - G Castronovo
- b ICS Maugeri, Neurorehabilitation Unit , Presidio Sanitario di Sciacca , Sciacca , Italy
| | - S Ruvolo
- b ICS Maugeri, Neurorehabilitation Unit , Presidio Sanitario di Sciacca , Sciacca , Italy
| | - C Montalbano
- b ICS Maugeri, Neurorehabilitation Unit , Presidio Sanitario di Sciacca , Sciacca , Italy
| | - V Loreto
- a Disorders of Consciousness Laboratory, ICS Maugeri, IRCCS , Scientific Institute of Telese Terme , Telese Terme , Italy
| | - L Trojano
- a Disorders of Consciousness Laboratory, ICS Maugeri, IRCCS , Scientific Institute of Telese Terme , Telese Terme , Italy.,c Neuropsychology Laboratory, Department of Psychology , University of Campania 'Luigi Vanvitelli' , Caserta , Italy
| | - A Estraneo
- a Disorders of Consciousness Laboratory, ICS Maugeri, IRCCS , Scientific Institute of Telese Terme , Telese Terme , Italy
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Cognitive reserve and self-efficacy as moderators of the relationship between stress exposure and executive functioning among spousal dementia caregivers. Int Psychogeriatr 2017; 29:615-625. [PMID: 28067184 DOI: 10.1017/s1041610216002337] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND A substantial literature has reported that stress negatively impacts on cognitive processes. As dementia caregiving can be stressful, it has been hypothesized that the challenges of dementia care may increase caregivers' own vulnerability to cognitive decline. Prefrontal processes are thought to be most vulnerable to stress; however, few studies have examined whether greater caregiver stress predicts poorer executive dysfunction, and no previous research has considered potential moderators of this relationship. We examined (1) whether greater psychological stress mediated a relationship between caregiver stress exposure and executive functioning and (2) whether greater self-efficacy and cognitive reserve (CR) moderated this relationship. METHOD Spousal dementia caregivers (n = 253) completed the Neuropsychiatric Inventory Questionnaire (stress exposure), the Perceived Stress Scale, the National Adult Reading Test (CR), the Fortinsky dementia-specific caregiver self-efficacy scale, and the Color Trails Test (executive functioning). Moderated mediation was tested using the PROCESS macro. Age, gender, and dementia risk factors were included as covariates. RESULTS Greater stress exposure indirectly predicted executive functioning through psychological stress. Stronger relationships between greater psychological stress and poorer executive functioning were observed among caregivers with lower CR; there was no evidence that self-efficacy moderated the relationship between stress exposure and psychological stress. CONCLUSIONS Our findings are in line with the idea that greater psychological stress in response to challenges associated with dementia care predicts poorer caregiver executive functioning, particularly among caregivers with low CR. However, these findings are cross sectional; it is also possible that poorer executive functioning contributes to greater caregiver stress.
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Hayslip B, Sanders RE, Herrington RS, Murphy MD, Moske AK. Depressive Symptomatology and Priming Effects Among Younger and Older Adults. Exp Aging Res 2017; 43:1-20. [PMID: 28067611 DOI: 10.1080/0361073x.2017.1258208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background/Study Context: This study examined the potential impact of self-reported depressive symptoms on the age-related capacity for inhibition and suppression, utilizing a negative priming paradigm. METHODS One hundred eighty-five community-residing adults varying in age (98 younger adults, Mage = 22; 87 older adults, Mage = 69) completed a nonconscious priming task, the Geriatric Depression Scale (GDS), the White Bear Suppression Inventory (WBSI), the Depression Sensitivity Scale (DSS), a free thought suppression task, as well as several measures indexing overall cognitive ability and psychomotor speed. Hierarchical regressions investigated the interaction of depressive symptoms with age and its effect on both positive and negative priming performance, indexing both facilitation and inhibition effects, respectively. RESULTS Results support the hypothesis that noncognitive factors affect effortful performance among older adults, although this influence varied with the specific component of the GDS, i.e., Dysphoria, Social Withdrawal, and Cognitive Control, and with the measure of depressive symptoms, i.e., GDS versus DSS. CONCLUSION These data suggest that aging's impact on both facilitation and inhibition, e.g., positive and negative priming, are to an extent, a function of individual differences in depressive symptoms that interact with age in influencing the necessity to reallocate one's cognitive resources to deal with depressive thoughts and feelings.
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Affiliation(s)
- Bert Hayslip
- a Department of Psychology , University of North Texas , Denton , Texas , USA
| | - Raymond E Sanders
- b Department of Psychology , The University of Akron , Akron , Ohio , USA
| | - Richard S Herrington
- c Computing and Information Technology Center , University of North Texas , Denton , Texas , USA
| | - Martin D Murphy
- b Department of Psychology , The University of Akron , Akron , Ohio , USA
| | - Amanda K Moske
- a Department of Psychology , University of North Texas , Denton , Texas , USA
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35
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Allen AP, Curran EA, Duggan Á, Cryan JF, Chorcoráin AN, Dinan TG, Molloy DW, Kearney PM, Clarke G. A systematic review of the psychobiological burden of informal caregiving for patients with dementia: Focus on cognitive and biological markers of chronic stress. Neurosci Biobehav Rev 2016; 73:123-164. [PMID: 27986469 DOI: 10.1016/j.neubiorev.2016.12.006] [Citation(s) in RCA: 156] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 10/28/2016] [Accepted: 12/09/2016] [Indexed: 12/18/2022]
Abstract
As the physiological impact of chronic stress is difficult to study in humans, naturalistic stressors are invaluable sources of information in this area. This review systematically evaluates the research literature examining biomarkers of chronic stress, including neurocognition, in informal dementia caregivers. We identified 151 papers for inclusion in the final review, including papers examining differences between caregivers and controls as well as interventions aimed at counteracting the biological burden of chronic caregiving stress. Results indicate that cortisol was increased in caregivers in a majority of studies examining this biomarker. There was mixed evidence for differences in epinephrine, norepinephrine and other cardiovascular markers. There was a high level of heterogeneity in immune system measures. Caregivers performed more poorly on attention and executive functioning tests. There was mixed evidence for memory performance. Interventions to reduce stress improved cognition but had mixed effects on cortisol. Risk of bias was generally low to moderate. Given the rising need for family caregivers worldwide, the implications of these findings can no longer be neglected.
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Affiliation(s)
- Andrew P Allen
- APC Microbiome Institute, Biosciences Institute, University College Cork, Cork, Ireland; Department of Psychiatry & Neurobehavioural Science, University College Cork, Cork, Ireland
| | - Eileen A Curran
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland; Department of Epidemiology & Public Health, University College Cork, Cork, Ireland
| | - Áine Duggan
- School of Medicine, University College Cork, Cork, Ireland
| | - John F Cryan
- APC Microbiome Institute, Biosciences Institute, University College Cork, Cork, Ireland; Department of Anatomy & Neuroscience, University College Cork, Cork, Ireland
| | - Aoife Ní Chorcoráin
- Centre for Gerontology & Rehabilitation, University College Cork, Cork, Ireland
| | - Timothy G Dinan
- APC Microbiome Institute, Biosciences Institute, University College Cork, Cork, Ireland; Department of Psychiatry & Neurobehavioural Science, University College Cork, Cork, Ireland
| | - D William Molloy
- Centre for Gerontology & Rehabilitation, University College Cork, Cork, Ireland
| | - Patricia M Kearney
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland; Department of Epidemiology & Public Health, University College Cork, Cork, Ireland
| | - Gerard Clarke
- APC Microbiome Institute, Biosciences Institute, University College Cork, Cork, Ireland; Department of Psychiatry & Neurobehavioural Science, University College Cork, Cork, Ireland.
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Paterson TSE, Yeung SE, Thornton WL. Positive affect predicts everyday problem-solving ability in older adults. Aging Ment Health 2016; 20:871-9. [PMID: 26033072 DOI: 10.1080/13607863.2015.1043619] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Increased symptom endorsement on the short form of the Centre for Epidemiologic Studies Depression (CES-D) Scale has been previously associated with lower everyday problem-solving (EPS) ability in older adults. However, given the multifactorial and complex nature of depressive symptoms, it remains unclear whether certain symptoms/aspects of depression account for this relationship. We examined established factor scores on the full version of the CES-D to assess their utility as predictors of EPS in an older adult cohort. METHODS Community-dwelling older adults (n = 103; age: 51-91) were administered the CES-D along with a measure of EPS ability assessing both social and practical EPS. Regression analyses were used to determine the relationships between variables. RESULTS Analyses revealed that increased CES-D scores predicted worse EPS ability in older adults (β = -.17, p < .05) beyond the effects of age, gender, and education. Regression analyses examining each CES-D factor score revealed that decreased positive affect (loss of hope/enjoyment in life; β = -.21, p < .01) remained the only significant predictor of decreased overall EPS scores beyond demographic variables, while depressed affect, interpersonal, and somatic factors were not significant predictors. Positive affect predicted both practical, as well as social EPS scores. CONCLUSIONS Current results extend previous findings by showing that the relationship between increased depressive symptoms and decreased EPS ability in older age may be primarily driven by anhedonia as opposed to other depressive symptoms.
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Affiliation(s)
| | - Sophie E Yeung
- a Department of Psychology , Simon Fraser University , Burnaby , Canada
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Lathan C, Wallace AS, Shewbridge R, Ng N, Morrison G, Resnick HE. Cognitive Health Assessment and Establishment of a Virtual Cohort of Dementia Caregivers. Dement Geriatr Cogn Dis Extra 2016; 6:98-107. [PMID: 27099613 PMCID: PMC4836114 DOI: 10.1159/000444390] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background Many factors impact caregivers’ cognitive health and, by extension, their ability to provide care. This study examined the relationship between psychosocial factors and cognitive performance among dementia caregivers and established a virtual cohort of caregivers for future research. Methods Data on 527 caregivers were collected via a Web-based survey that assessed cognitive performance. Caregiver data were compared to corresponding data from 527 age-, race-, gender-, and education-matched controls from a normative database. Caregiver self-reported sleep, stress, health, and social support were also assessed. Results Caregivers performed significantly worse than controls on 3 of 5 cognitive subtests. Stress, sleep, perceived support, self-rated health, years of caregiving, race, and gender were significant predictors of cognitive performance. Conclusion In this sample of dementia caregivers, psychosocial factors interacted in complex ways to impact cognitive performance. Further investigation is needed to better understand how these factors affect cognitive performance among caregivers. This could be accomplished by the establishment of a virtual cohort that facilitates the development of digital tools to support the evaluation and management of caregiver needs in a manner that helps them remain effective in their caregiving roles.
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Affiliation(s)
| | | | | | - Nicole Ng
- Lumos Labs, San Francisco, Calif., USA
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Martín-García R, Martín-Avila G, la Rubia-Marcos MD, Maroto-Rodríguez R, Ortega-Angulo C, Carreras Rodriguez MT, Abad Santos F, Gago Veiga AB. Consumption of Drugs and Nonpharmacological Therapies in Caregivers of Patients with Alzheimer's Disease: A Case-Control Study in Madrid. Dement Geriatr Cogn Dis Extra 2016; 6:68-77. [PMID: 27065471 PMCID: PMC4821148 DOI: 10.1159/000442942] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background Dementia is a neurodegenerative disease whose prevalence is rising, and the need for assistance to patients becomes indispensable. The different types of dementia and their treatments have been widely studied; however, the health status of caregivers also requires our attention. Objective The aim of our research was to evaluate whether caregivers of patients with dementia consume more medications than the general population, indicating underlying pathologies. Methods A total of 91 caregivers of dementia patients were interviewed and their answers were compared with those from a control group of 48 people, taking into account demographic data, characteristics of patients and caregivers, pharmacological and nonpharmacological treatments and burden. Results Caregivers showed a significantly higher consumption of anxiolytics, antidepressants and antiplatelets (22.3, 13.2 and 11%, respectively) than the control group (14.6, 0 and 0%, respectively). Moreover, 45.1% of the caregivers used nonpharmacological therapies compared with 6.2% of the control group. There was a tendency to take more medications in those caregivers suffering from burden and those who had to take care of patients with behavioral changes. Conclusion Caregivers of dementia patients need more pharmacological and nonpharmacological therapies. They are a risk group that needs better care from the health system.
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Affiliation(s)
| | | | | | | | | | - María Teresa Carreras Rodriguez
- Alzheimer's Disease and Other Cognitive Disorders Unit, Department of Neurology, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain
| | - Francisco Abad Santos
- Clinical Pharmacology Service, Hospital Universitario de la Princesa, Instituto Teófilo Hernando, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain
| | - Ana Beatriz Gago Veiga
- Alzheimer's Disease and Other Cognitive Disorders Unit, Department of Neurology, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain
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Depressive Mood and Testosterone Related to Declarative Verbal Memory Decline in Middle-Aged Caregivers of Children with Eating Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13030286. [PMID: 27072418 PMCID: PMC4808949 DOI: 10.3390/ijerph13030286] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 02/25/2016] [Accepted: 03/01/2016] [Indexed: 11/17/2022]
Abstract
Caring for children diagnosed with a chronic psychological disorder such as an eating disorder (ED) can be used as a model of chronic stress. This kind of stress has been reported to have deleterious effects on caregivers’ cognition, particularly in verbal declarative memory of women caregivers. Moreover, high depressive mood and variations in testosterone (T) levels moderate this cognitive decline. The purpose of this study was to characterize whether caregivers of individuals with EDs (n = 27) show declarative memory impairments compared to non-caregivers caregivers (n = 27), using for this purpose a standardized memory test (Rey’s Auditory Verbal Learning Test). Its purpose was also to examine the role of depressive mood and T in memory decline. Results showed that ED caregivers presented high depressive mood, which was associated to worse verbal memory performance, especially in the case of women. In addition, all caregivers showed high T levels. Nonetheless, only in the case of women caregivers did T show a curvilinear relationship with verbal memory performance, meaning that the increases of T were associated to the improvement in verbal memory performance, but only up to a certain point, as after such point T continued to increase and memory performance decreased. Thus, chronic stress due to caregiving was associated to disturbances in mood and T levels, which in turn was associated to verbal memory decline. These findings should be taken into account in the implementation of intervention programs for helping ED caregivers cope with caregiving situations and to prevent the risk of a pronounced verbal memory decline.
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Pertl MM, Lawlor BA, Robertson IH, Walsh C, Brennan S. Risk of Cognitive and Functional Impairment in Spouses of People With Dementia: Evidence From the Health and Retirement Study. J Geriatr Psychiatry Neurol 2015; 28:260-71. [PMID: 26071444 DOI: 10.1177/0891988715588834] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Caring for a spouse with dementia is a chronic stressor that may compromise caregivers' own cognitive functioning and capacity to provide adequate care. We examined whether having (i) a spouse with dementia and (ii) a spouse who requires assistance with activities of daily living predicted cognitive and functional impairments in respondents to the Health and Retirement Study (n = 7965). Respondents who had a spouse who requires care had poorer cognitive functioning, whereby this relationship was significantly stronger for male respondents. Having a spouse with dementia moderated the relationship between income and cognition and predicted caregiver functional impairment, though not when depression was controlled. Although we found no significant differences on any individual cognitive domains between 179 dementia caregivers and sociodemographically matched noncaregivers, our findings suggest that caregivers, especially men, and low-income individuals who have a spouse with dementia are more vulnerable to adverse cognitive outcomes. Targeting depression in spouses of people with dementia may help to prevent functional impairments.
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Affiliation(s)
- Maria M Pertl
- Neuro-Enhancement for Independent Lives (NEIL) Programme, School of Psychology, Trinity College Institute of Neuroscience (TCIN), Trinity College Dublin, Dublin 2, Ireland
| | - Brian A Lawlor
- Neuro-Enhancement for Independent Lives (NEIL) Programme, School of Medicine, Trinity College Institute of Neuroscience (TCIN), Trinity College Dublin, Dublin 2, Ireland
| | - Ian H Robertson
- Neuro-Enhancement for Independent Lives (NEIL) Programme, School of Psychology, Trinity College Institute of Neuroscience (TCIN), Trinity College Dublin, Dublin 2, Ireland
| | - Cathal Walsh
- Department of Statistics, Trinity College Dublin, Dublin, Ireland
| | - Sabina Brennan
- Neuro-Enhancement for Independent Lives (NEIL) Programme, School of Psychology, Trinity College Institute of Neuroscience (TCIN), Trinity College Dublin, Dublin 2, Ireland
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Dassel KB, Carr DC, Vitaliano P. Does Caring for a Spouse With Dementia Accelerate Cognitive Decline? Findings From the Health and Retirement Study. THE GERONTOLOGIST 2015; 57:319-328. [DOI: 10.1093/geront/gnv148] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 09/17/2015] [Indexed: 11/12/2022] Open
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Romero-Martínez A, González-Bono E, Salvador A, Moya-Albiol L. Declarative verbal memory impairments in middle-aged women who are caregivers of offspring with autism spectrum disorders: The role of negative affect and testosterone. Memory 2015; 24:640-9. [DOI: 10.1080/09658211.2015.1034727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Corrêa M, Vedovelli K, Giacobbo B, de Souza C, Ferrari P, de Lima Argimon I, Walz J, Kapczinski F, Bromberg E. Psychophysiological correlates of cognitive deficits in family caregivers of patients with Alzheimer Disease. Neuroscience 2015; 286:371-82. [DOI: 10.1016/j.neuroscience.2014.11.052] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 11/19/2014] [Accepted: 11/25/2014] [Indexed: 12/19/2022]
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Abstract
PURPOSE OF REVIEW Carers of people with dementia are at increased risk of experiencing psychological distress. This article reviews recent findings on the role of personality traits for psychological outcomes for carers of people with dementia. RECENT FINDINGS Several studies have now established that personality influences the caregiving experience, carer well-being and outcomes such as coping ability, burden and caregiving style. Several moderators of these associations have also been identified such as the effect of kinship and type of dementia. There is consistent evidence that carer personality characteristics influence the progression of the disease such as cognitive decline and severity. Most of the recent studies identified in this review are cross-sectional. SUMMARY Taken together, these results indicate that personality is an important psychological resource for carers. Recent findings indicate that personality traits are associated with and influence both carer and patient outcomes. Future research is necessary to guide interventions and to expand further on our understanding of how personality factors shape adjustment to the caregiving role and how these impact on the progression of the disease.
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Vitaliano PP, Strachan E, Dansie E, Goldberg J, Buchwald D. Does caregiving cause psychological distress? The case for familial and genetic vulnerabilities in female twins. Ann Behav Med 2014; 47:198-207. [PMID: 24264772 DOI: 10.1007/s12160-013-9538-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Informal caregiving can be deleterious to mental health, but research results are inconsistent and may reflect an interaction between caregiving and vulnerability to stress. METHODS We examined psychological distress among 1,228 female caregiving and non-caregiving twins. By examining monozygotic and dizygotic twin pairs discordant for caregiving, we assessed the extent to which distress is directly related to caregiving or confounded by common genes and environmental exposures. RESULTS Caregiving was associated with distress as measured by mental health functioning, anxiety, perceived stress, and depression. The overall association between caregiving and distress was confounded by common genes and environment for mental health functioning, anxiety, and depression. Common environment also confounded the association of caregiving and perceived stress. CONCLUSIONS Vulnerability to distress is a factor in predicting caregivers' psychosocial functioning. Additional research is needed to explicate the mechanisms by which common genes and environment increase the risk of distress among informal caregivers.
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Affiliation(s)
- Peter P Vitaliano
- Department of Psychiatry and Behavioral Sciences, University of Washington, PO Box 356560, Seattle, WA, 98195, USA,
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Lovell B, Elliot H, Liu CCS, Wetherell MA. Memory failures for everyday tasks in caregivers of children with autism. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:3057-3061. [PMID: 25128790 DOI: 10.1016/j.ridd.2014.07.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 07/07/2014] [Indexed: 06/03/2023]
Abstract
The stress of caring for a loved one with chronic illness has been linked with impairments in cognitive processes such as attention and problem solving, though few studies have examined the impact on memory. Compromised cognition, in particular, aspects of everyday functioning such as remembering medical instructions and appointments, might affect caregivers' ability to maintain the consistency and quality of care needed by the child. A sample of 31 caregivers of children with autism and 51 parents of neuro-typical children completed an electronic survey assessing their levels of psychological distress and everyday memory. Perceived stress scores were higher in the caregiver group, as were self-reported memory failures for everyday tasks. The negative impact of caregiver stress on everyday memory was particularly salient among caregivers experiencing higher perceived levels of stress. These findings have implications for interventions that aim to improve caregivers' cognitive well being through targeting the psychological sequelae associated with the caregiving experience.
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Affiliation(s)
- Brian Lovell
- Stress Research Group, Department of Psychology, Northumbria University, UK.
| | - Helen Elliot
- Stress Research Group, Department of Psychology, Northumbria University, UK
| | - Chris Che Sung Liu
- Stress Research Group, Department of Psychology, Northumbria University, UK
| | - Mark A Wetherell
- Stress Research Group, Department of Psychology, Northumbria University, UK
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Distress among caregivers of phase I trial participants: a cross-sectional study. Support Care Cancer 2014; 22:3331-40. [PMID: 25120010 DOI: 10.1007/s00520-014-2380-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 07/31/2014] [Indexed: 01/22/2023]
Abstract
PURPOSE The number of patients with cancer enrolling in phase I trials is expected to increase as these trials incorporate patient selection and exhibit greater efficacy in the era of targeted therapies. Despite the fact that people with advanced cancer often require a caregiver, little is known about the experience of caregivers of people enrolling in oncology phase I clinical trials. We conducted a cross-sectional study assessing the distress and emotion regulation of caregivers of phase I trial participants to inform the design of future interventions targeting the unique needs of this population. METHODS Caregivers of oncology patients were approached at the patient's phase I clinical trial screening visit. Caregiver participants completed a one-time survey incorporating validated instruments to comprehensively assess distress and emotion regulation. Basic demographic information about both the caregiver and patient was collected. RESULTS Caregivers exhibited greater distress than population norms. Emotion regulation was also moderately impaired. Respondents identified positive aspects of caregiving despite exhibiting moderate distress. CONCLUSION Enrollment of a patient in a phase I clinical trial is a time of stress for their caregivers. This pilot study demonstrates the feasibility of engaging caregivers of phase I trial participants and the need to better support them through this component of their caregiving experience.
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Abstract
BACKGROUND Chronic stress negatively affects health and well-being. A growing population of informal dementia caregivers experience chronic stress associated with extraordinary demands of caring for a relative with dementia. This review summarizes physiological and functional changes due to chronic dementia caregiver stress. METHODS A literature search for papers assessing effects of dementia caregiving was conducted focusing on publications evaluating differences between caregivers and non-caregivers in objective measures of health and cognition. RESULTS The review identified 37 studies describing data from 4,145 participants including 749 dementia caregivers and 3,396 non-caregiver peers. Objective outcome measures affected in dementia caregivers included markers of dyscoagulation, inflammation, and cell aging as well as measures of immune function, sleep, and cognition. Though diverse in designs, samples, and study quality, the majority of the studies indicated increased vulnerability of dementia caregivers to detrimental changes in health and cognition. Demographic and personality characteristics moderating or mediating effects of chronic stress in caregivers were also reviewed. CONCLUSIONS There is accumulating evidence that chronic dementia caregiver stress increases their vulnerability to disease and diminishes their ability to provide optimal care. Clinicians and society need to appreciate the extent of deleterious effects of chronic stress on dementia caregiver health.
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Rote S, Angel JL, Markides K. Health of elderly Mexican American adults and family caregiver distress. Res Aging 2014; 37:306-31. [PMID: 25651573 DOI: 10.1177/0164027514531028] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Using newly available data on family caregivers from a large epidemiological study of elderly Mexican-origin adults (Hispanic Established Population for the Epidemiologic Study of the Elderly [HEPESE], 2010/2011), we identify which types of impairment (functional, psychological, and cognitive) in the elderly individual are associated with family caregiver depressive symptoms. Results from ordinary least squares regressions using 626 caregiver-care recipient dyads demonstrate that more severe mobility limitations (Performance-Oriented Mobility Assessment), social disability (instrumental activities of daily living), neuropsychiatric disturbances related to cognitive decline (Neuropsychiatric Inventory), and depressive symptoms in the elderly subject are positively associated with caregiver psychological distress. Perceived social stress partially accounts for these associations. We also identify certain segments of this caregiver population that are especially vulnerable to burden when caring for a family member with high levels of impairment, namely female and low-income caregivers. These vulnerabilities should be the focus of intervention efforts to reduce stress and improve the emotional and psychological well-being of Mexican-origin caregivers.
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Affiliation(s)
- Sunshine Rote
- Sealy Center on Aging, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Jacqueline L Angel
- LBJ School of Public Affairs and Department of Sociology, The University of Texas at Austin, Austin, TX, USA
| | - Kyriakos Markides
- Preventive Medicine and Community Health, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
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Meyer OL, Geller S, He E, González HM, Hinton L. Acculturation and depressive symptoms in latino caregivers of cognitively impaired older adults. Int Psychogeriatr 2014; 26:1-10. [PMID: 24717691 PMCID: PMC4192100 DOI: 10.1017/s1041610214000490] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACT Background: Caregiving for older adults is a growing public health concern because of the negative psychological effects it has on caregivers. Despite the growing Latino caregiver population, little is known regarding how the effects of acculturation on caregiver depressive symptoms might vary by caregiver age. This study aimed to examine the relationship between language acculturation and depressive symptoms in Latino caregivers, and to test whether this relationship was moderated by age. Methods: Ninety-four Latino caregivers of cognitively impaired older adults with and without dementia were identified through an ongoing epidemiological cohort study. Caregivers were interviewed in their homes, in either Spanish or English. A Poisson regression was used to analyze the caregiver characteristics associated with caregiver depressive symptoms. Results: Language acculturation was positively associated with caregiver depressive symptoms, as was age, female gender, and being married or living with someone. Those with excellent or good health and who had spent more than one year caregiving had lower depressive symptoms. Finally, the positive relationship between language acculturation and depressive symptoms was increased in older caregivers. Conclusions: Language acculturation appears to be a risk factor for depressive symptoms in Latino caregivers of cognitively impaired older adults. The relationship between language acculturation and depressive symptoms is complex such that caregiver age and health status further nuance this relationship. Future research should explore the independent and interactive effects of these variables on depressive symptoms.
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Affiliation(s)
- Oanh L Meyer
- Department of Neurology, University of California, Davis, California, USA
| | - Sue Geller
- Department of Mathematics, Texas A&M University, Texas, USA
| | - Emily He
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, USA
| | - Hector M González
- Department of Epidemiology and Biostatistics, Michigan State University, Michigan, USA
| | - Ladson Hinton
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, California, USA
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