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Harmell AL, Kaup AR, Xia F, Jacobs DR, Launer LJ, Davatzikos C, Sidney S, Bryan N, Yaffe K. P4-365: ASSOCIATION OF COGNITIVE LEISURE ACTIVITY WITH COGNITIVE FUNCTION AND BRAIN STRUCTURE IN MIDLIFE: THE CARDIA STUDY. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.4036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Allison R. Kaup
- San Francisco VA Medical Center / University of California San Francisco; San Francisco CA USA
| | - Feng Xia
- NCIRE-The Veterans Health Research Institute; San Francisco CA USA
| | | | | | | | | | - Nick Bryan
- University of Texas at Austin; Austin TX USA
| | - Kristine Yaffe
- University of California, San Francisco; San Francisco CA USA
- San Francisco VA Health Care System; San Francisco CA USA
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Kaup AR, Schachtner J, Byers AL, Barnes DE, Anguera JA, Harmell AL, Amaya MP, Gross M, Yaffe K. P1-054: MOBILE COGNITIVE INTERVENTION IN OLDER VETERANS WITH TRAUMATIC BRAIN INJURY: RESULTS FROM THE BRAVE (BRAIN AGING IN VETERANS) TRAINING PILOT STUDY. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Allison R. Kaup
- San Francisco VA Health Care System; San Francisco CA USA
- The Neurology Center of Southern California; Carlsbad CA USA
- University of California, San Francisco; San Francisco CA USA
| | | | - Amy L. Byers
- San Francisco VA Health Care System; San Francisco CA USA
- University of California, San Francisco; San Francisco CA USA
| | - Deborah E. Barnes
- San Francisco VA Health Care System; San Francisco CA USA
- University of California, San Francisco; San Francisco CA USA
| | | | | | - Maria-Paulina Amaya
- San Francisco VA Health Care System; San Francisco CA USA
- The Neurology Center of Southern California; Carlsbad CA USA
| | - Margaret Gross
- San Francisco VA Health Care System; San Francisco CA USA
| | - Kristine Yaffe
- San Francisco VA Health Care System; San Francisco CA USA
- University of California, San Francisco; San Francisco CA USA
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Kaup AR, Harmell AL, Yaffe K. Conscientiousness Is Associated with Lower Risk of Dementia among Black and White Older Adults. Neuroepidemiology 2019; 52:86-92. [PMID: 30602170 DOI: 10.1159/000492821] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 08/08/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND While some personality traits may reduce risk of dementia, this is controversial and has not been studied as much among diverse populations. We examined associations between 2 traits - Conscientiousness and Openness to Experience - and risk of dementia among black and white older adults. METHODS We studied 875 older adults (ages 71-82, 47% black) without prevalent dementia from the Health, Aging and Body Composition study, who completed the NEO Five-Factor Inventory for Conscientiousness and Openness to Experience. Incident dementia over 8 years (mean = 6.9 years) was determined by hospital records, medications, or ≥1.5 SD race-specific decline on the Modified Mini-Mental State Examination. In adjusted models, we investigated associations between each trait and risk of dementia, including for race interactions. RESULTS Associations between personality traits and dementia risk did not differ by race (interactions: p > 0.7). Higher Conscientiousness was associated with lower dementia risk (adjusted HR per 1SD = 0.78; 95% CI 0.65-0.94). There was no association for Openness to Experience (adjusted HR per 1SD = 0.88; 95% CI 0.71-1.08). CONCLUSIONS Higher Conscientiousness is associated with lower dementia risk, even among diverse populations. Higher Conscientiousness may be protective, or lower Conscientiousness may be an early symptom of neurodegenerative disease.
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Affiliation(s)
- Allison R Kaup
- Research Service, San Francisco VA Health Care System, San Francisco, California, USA, .,Mental Health Service, San Francisco VA Health Care System, San Francisco, California, USA, .,Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California, USA,
| | - Alexandrea L Harmell
- Mental Health Service, San Francisco VA Health Care System, San Francisco, California, USA
| | - Kristine Yaffe
- Research Service, San Francisco VA Health Care System, San Francisco, California, USA.,Mental Health Service, San Francisco VA Health Care System, San Francisco, California, USA.,Department of Neurology and Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
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Abstract
OBJECTIVES Optimizing the research consent process simultaneously fosters respect for autonomy and protection of those with diminished capacity for autonomy. This study evaluated the effectiveness of an enhanced research consent procedure, employing multimedia disclosure and corrective feedback, in improving decisional capacity among 114 people with mild-to-moderate Alzheimer's disease (AD) and 134 non-psychiatric comparison (NC) subjects. METHODS Participants were randomized to consent type (routine versus enhanced) and protocol type (lower versus higher risk). Outcomes included a 5-item questionnaire assessing immediate comprehension, MacArthur Competence Assessment Tool for Clinical Research assessing four components of decision-making capacity, and categorical decisional capacity (based on a cut-score established in reference to expert judgments for a subset of participants). RESULTS There was no significant effect of the enhanced consent procedure, relative to routine consent, on immediate comprehension or decisional capacity. CONCLUSIONS Multimedia tools do not appear to be the solution to better consent for AD research. CLINICAL IMPLICATIONS Given the ethical primacy of informed consent and issues of justice for impaired populations who might be harmed by an absence of research-based treatment advances, continued search for ways to more meaningfully engage people with AD in the consent or assent process is warranted.
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Affiliation(s)
- Barton W Palmer
- a Veterans Affairs San Diego Healthcare System , San Diego , California , USA.,b Veterans Medical Research Foundation , San Diego , California , USA.,c Department of Psychiatry , University of California, San Diego , La Jolla , California , USA.,d Center for Healthy Aging/Stein Institute for Research on Aging , University of California, San Diego , La Jolla , California , USA
| | - Alexandrea L Harmell
- c Department of Psychiatry , University of California, San Diego , La Jolla , California , USA.,d Center for Healthy Aging/Stein Institute for Research on Aging , University of California, San Diego , La Jolla , California , USA.,e San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology , San Diego , California , USA.,f Mental Health Service , San Francisco VA Healthcare System , San Francisco , California , USA
| | - Laura B Dunn
- g Department of Psychiatry and Behavioral Sciences , Stanford University , Stanford , California , USA
| | - Scott Y Kim
- h Department of Bioethics , National Institute of Health , Bethesda , Maryland , USA
| | - Luz L Pinto
- b Veterans Medical Research Foundation , San Diego , California , USA.,c Department of Psychiatry , University of California, San Diego , La Jolla , California , USA.,d Center for Healthy Aging/Stein Institute for Research on Aging , University of California, San Diego , La Jolla , California , USA
| | - Shahrokh Golshan
- b Veterans Medical Research Foundation , San Diego , California , USA.,c Department of Psychiatry , University of California, San Diego , La Jolla , California , USA
| | - Dilip V Jeste
- c Department of Psychiatry , University of California, San Diego , La Jolla , California , USA.,d Center for Healthy Aging/Stein Institute for Research on Aging , University of California, San Diego , La Jolla , California , USA
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Abstract
It is often necessary for neuropsychologists, clinical psychologists, and other healthcare professionals to assess an individual's capacity to consent to treatment related to healthcare. This task can be challenging and requires a delicate balance of both respect for individuals' autonomy, as well as the protection of individuals with diminished capacity to make an autonomous decision. The purpose of the present review is to provide an overview of the conceptual model of decisional capacity as well as a brief summary of some of the currently available instruments designed to help evaluate medical decision making. In addition, current empirical literature on the relationship between neuropsychological abilities and decision-making capacity is discussed and a brief set of recommendations is provided to further aid clinicians or consultants when they are required to complete the ethically important but difficult task of making determinations about healthcare decision-making capacity.
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Affiliation(s)
- Barton W Palmer
- Department of Psychiatry, University of California, San Diego, CA, USA Veterans Medical Research Foundation, San Diego, CA, USA Veterans Affairs San Diego Healthcare System, San Diego, CA, USA Center for Healthy Aging/Stein Institute for Research on Aging, University of California, San Diego, CA, USA
| | - Alexandrea L Harmell
- Department of Psychiatry, University of California, San Diego, CA, USA Center for Healthy Aging/Stein Institute for Research on Aging, University of California, San Diego, CA, USA San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology , San Diego, CA, USA
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Abstract
OBJECTIVE Investigators conducting Alzheimer's disease (AD) research need to consider participants' capacity to consent. Cognitive functioning is a significant predictor of decisional capacity, but there is a dearth of information on the influence of neuropsychiatric symptoms in AD on decisional capacity. We examined the rates of decisional capacity associated with two types of research protocols, and the association of capacity with neuropsychiatric symptoms and other participant characteristics. METHODS We comprehensively evaluated decisional capacity among 64 patients with mild-to-moderate AD and 70 healthy comparison (HC) subjects randomized to consider either a medium risk or higher risk hypothetical research protocol. Additional measures included sociodemographics, cognitive deficits, and neuropsychiatric symptoms. RESULTS Twenty AD patients (31.3%) and 67 HCs (95.7%) were deemed capable; 44 AD patients (68.8%) and 3 HCs (4.3%) incapable of consent. Age, education, and severity of cognitive deficits were associated with incapable status; there were no significant associations with severity of neuropsychiatric symptoms or protocol risk level. CONCLUSIONS Findings highlight the importance of understanding of capacity and its assessment among people with AD, rather than treating AD diagnosis as synonymous with impaired capacity. As novel treatments move from bench to bedside, methods of assessing and addressing capacity impairment must similarly advance. CLINICAL IMPLICATIONS In assessing research consent capacity, use structured assessments with population specific cut scores interpreted in the context of the person's background including education, culture, and language. Individuals should be encouraged to execute research proxy documents when able.
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Affiliation(s)
- Barton W. Palmer
- Department of Psychiatry, University of California, San Diego
- Veterans Medical Research Foundation, San Diego, CA
- Veterans Affairs San Diego Healthcare System
- Center for Healthy Aging/Stein Institute for Research on Aging, University of California, San Diego
| | - Alexandrea L. Harmell
- Department of Psychiatry, University of California, San Diego
- Center for Healthy Aging/Stein Institute for Research on Aging, University of California, San Diego
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA
| | - Luz L. Pinto
- Department of Psychiatry, University of California, San Diego
- Center for Healthy Aging/Stein Institute for Research on Aging, University of California, San Diego
| | - Laura B. Dunn
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | - Scott Y. H. Kim
- Department of Bioethics, National Institute of Health, Bethesda, MD
| | - Shahrokh Golshan
- Department of Psychiatry, University of California, San Diego
- Veterans Affairs San Diego Healthcare System
| | - Dilip V. Jeste
- Department of Psychiatry, University of California, San Diego
- Center for Healthy Aging/Stein Institute for Research on Aging, University of California, San Diego
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Harmell AL, Neikrug AB, Palmer BW, Avanzino JA, Liu L, Maglione JE, Natarajan L, Corey-Bloom J, Loredo JS, Ancoli-Israel S. Obstructive Sleep Apnea and Cognition in Parkinson's disease. Sleep Med 2016; 21:28-34. [PMID: 27448468 DOI: 10.1016/j.sleep.2016.01.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 12/30/2015] [Accepted: 01/07/2016] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) is very common in Parkinson's disease (PD). OSA is known to affect patients' cognition. The present study assessed whether PD patients with OSA (PD + OSA) score lower on cognitive measures than those without OSA (PD - OSA). In addition, this study evaluated whether treating the OSA with continuous positive airway pressure (CPAP) in PD + OSA patients results in an improved cognitive functioning. METHODS Eighty-six patients with PD underwent an overnight polysomnography screen for OSA and were administered the Mini-Mental Status Exam (MMSE) and the Montreal Cognitive Assessment (MoCA). This resulted in 38 patients with PD + OSA who were randomly assigned to receive either therapeutic CPAP for 6 weeks (n = 19) or placebo CPAP for three weeks followed by therapeutic CPAP for three weeks (n = 19). Intervention participants completed a neurocognitive battery at baseline and 3- and 6-week time-points. RESULTS Patients with PD + OSA scored significantly lower than PD - OSA on the MMSE and MoCA after controlling for age, education, and PD severity. OSA was a significant predictor of cognition (MMSE p <0.01; MoCA p = 0.028).There were no significant changes between groups in cognition when comparing three weeks of therapeutic CPAP with 3 weeks of placebo CPAP. Comparisons between pre-treatment and 3-week post-therapeutic CPAP for the entire sample also revealed no significant changes on overall neuropsychological (NP) scores. CONCLUSIONS Findings suggest that PD patients with OSA show worse cognitive functioning on cognitive screening measures than those without OSA. However, OSA treatment after three or six weeks of CPAP may not result in overall cognitive improvement in patients with PD.
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Affiliation(s)
- Alexandrea L Harmell
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA
| | - Ariel B Neikrug
- Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA
| | - Barton W Palmer
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA; Stein Institute for Research on Aging, CA, USA; Veterans Administration Healthcare System, San Diego, CA, USA
| | - Julie A Avanzino
- Department of Psychiatry, University of California, San Diego, CA, USA; Stein Institute for Research on Aging, CA, USA
| | - Lianqi Liu
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Jeanne E Maglione
- Department of Psychiatry, University of California, San Diego, CA, USA; Stein Institute for Research on Aging, CA, USA; Veterans Administration Healthcare System, San Diego, CA, USA
| | - Loki Natarajan
- Department of Family and Preventative Medicine, University of California, San Diego, CA, USA
| | - Jody Corey-Bloom
- Department of Neurosciences, University of California, San Diego, CA, USA
| | - Jose S Loredo
- Veterans Administration Healthcare System, San Diego, CA, USA; Department of Medicine, University of California, San Diego, CA, USA
| | - Sonia Ancoli-Israel
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA; Stein Institute for Research on Aging, CA, USA; Department of Medicine, University of California, San Diego, CA, USA.
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Abstract
OBJECTIVES Our objective was to examine the association of mobile phone use and ownership with psychopathology, cognitive functioning, and functional outcome in 196 outpatients aged 40 years and older who were diagnosed with schizophrenia. METHOD Participants reported their past and current mobile phone use on a standardized self-report scale and they were administered tests of global cognition, functional capacity, and informant-rated functional outcome. RESULTS The great majority of subjects had used a mobile phone (78%) but few currently owned one (27%). After adjusting for age (mean age 51), any past mobile phone use was associated with less severe negative symptoms, and higher global cognitive performance, functional capacity, and functional outcome. A total of 60% of participants reported being comfortable with mobile phones, but comfort was not associated with any cognitive or functional outcomes. CONCLUSION Most of the older patients with schizophrenia have used mobile phones and lifetime mobile phone use is a positive indicator of cognitive and functional status.
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Affiliation(s)
- Colin A Depp
- Department of Psychiatry, UC San Diego, La Jolla, California, VA San Diego Healthcare System, San Diego, California
| | | | - Ipsit V Vahia
- Department of Psychiatry, UC San Diego, La Jolla, California
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Moore RC, Harmell AL, Harvey PD, Bowie CR, Depp CA, Pulver AE, McGrath JA, Patterson TL, Cardenas V, Wolyniec P, Thornquist MH, Luke JR, Palmer BW, Jeste DV, Mausbach BT. Improving the understanding of the link between cognition and functional capacity in schizophrenia and bipolar disorder. Schizophr Res 2015; 169:121-127. [PMID: 26427917 PMCID: PMC4681671 DOI: 10.1016/j.schres.2015.09.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 09/10/2015] [Accepted: 09/15/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Deficits in cognitive functioning are related to functional disability in people with serious mental illness. Measures of functional capacity are commonly used as a proxy for functional disabilities for cognitive remediation programs, and robust linear relationships between functional capacity and cognitive deficits are frequently observed. This study aimed to determine whether a curvilinear relationship better approximates the association between cognitive functioning and functional capacity. METHOD Two independent samples were studied. Study 1: participants with schizophrenia (n=435) and bipolar disorder (n=390) aged 18-83 completed a neuropsychological battery and a performance-based measure of functional capacity. Study 2: 205 participants with schizophrenia (age range=39-72) completed a brief neuropsychological screening battery and a performance-based measure of functional capacity. For both studies, linear and quadratic curve estimations were conducted with cognitive performance predicting functional capacity scores. RESULTS Significant linear and quadratic trends were observed for both studies. Study 1: in both the schizophrenia and bipolar participants, when cognitive composite z-scores were >0 (indicating normal to above normal performance), cognition was not related to functional capacity. Study 2: when neuropsychological screening battery z-scores were >-1 (indicating low average to average performance), cognition was not related to functional capacity. CONCLUSIONS These results illustrate that in cognitively normal adults with serious mental illness, the relationship between cognitive function and functional capacity is relatively weak. These findings may aid clinicians and researchers determine who may optimally benefit from cognitive remediation programs, with greater benefits possibly being achieved for individuals with cognitive deficits relative to individuals with normal cognition.
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Affiliation(s)
- Raeanne C. Moore
- Department of Psychiatry, University of California, San Diego,Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, CA
| | - Alexandrea L. Harmell
- Department of Psychiatry, University of California, San Diego,San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
| | | | | | - Colin A. Depp
- Department of Psychiatry, University of California, San Diego,Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, CA,VA San Diego Healthcare System, San Diego, California
| | - Ann E. Pulver
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - John A McGrath
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, United States.
| | | | - Veronica Cardenas
- Department of Psychiatry, University of California, San Diego, United States; Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, CA, United States.
| | - Paula Wolyniec
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, United States.
| | - Mary H. Thornquist
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - James R. Luke
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Barton W. Palmer
- Department of Psychiatry, University of California, San Diego,Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, CA
| | - Dilip V. Jeste
- Department of Psychiatry, University of California, San Diego,Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, CA
| | - Brent T. Mausbach
- Department of Psychiatry, University of California, San Diego,Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, CA
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Abstract
Population aging is an enormous public health issue and there is clear need for strategies to maximize opportunities for successful aging. Many psychiatric illnesses are increasingly thought to be associated with accelerated aging, therefore emerging data on individual and policy level interventions that alter typical aging trajectories are relevant to mental health practitioners. Although the determinants and definition of successful aging remain controversial, increasing data indicate that psychiatric illnesses directly impact biological aging trajectories and diminish lifestyle, psychological, and socio-environmental factors that seem to reduce risk of morbidity and mortality. Many interventions designed to enhance the normal course of aging may be adjunctive approaches to management of psychiatric illnesses. We highlight recent data on interventions seeking to promote healthy aging, such as cognitive remediation, physical activity, nutrition, and complementary and alternative treatments for older people with and without psychiatric illnesses.
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Bangen KJ, Nation DA, Clark LR, Harmell AL, Wierenga CE, Dev SI, Delano-Wood L, Zlatar ZZ, Salmon DP, Liu TT, Bondi MW. Interactive effects of vascular risk burden and advanced age on cerebral blood flow. Front Aging Neurosci 2014; 6:159. [PMID: 25071567 PMCID: PMC4083452 DOI: 10.3389/fnagi.2014.00159] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 06/19/2014] [Indexed: 01/24/2023] Open
Abstract
Vascular risk factors and cerebral blood flow (CBF) reduction have been linked to increased risk of cognitive impairment and Alzheimer's disease (AD); however the possible moderating effects of age and vascular risk burden on CBF in late life remain understudied. We examined the relationships among elevated vascular risk burden, age, CBF, and cognition. Seventy-one non-demented older adults completed an arterial spin labeling MR scan, neuropsychological assessment, and medical history interview. Relationships among vascular risk burden, age, and CBF were examined in a priori regions of interest (ROIs) previously implicated in aging and AD. Interaction effects indicated that, among older adults with elevated vascular risk burden (i.e., multiple vascular risk factors), advancing age was significantly associated with reduced cortical CBF whereas there was no such relationship for those with low vascular risk burden (i.e., no or one vascular risk factor). This pattern was observed in cortical ROIs including medial temporal (hippocampus, parahippocampal gyrus, uncus), inferior parietal (supramarginal gyrus, inferior parietal lobule, angular gyrus), and frontal (anterior cingulate, middle frontal gyrus, medial frontal gyrus) cortices. Furthermore, among those with elevated vascular risk, reduced CBF was associated with poorer cognitive performance. Such findings suggest that older adults with elevated vascular risk burden may be particularly vulnerable to cognitive change as a function of CBF reductions. Findings support the use of CBF as a potential biomarker in preclinical AD and suggest that vascular risk burden and regionally-specific CBF changes may contribute to differential age-related cognitive declines.
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Affiliation(s)
- Katherine J Bangen
- Psychology Service, VA San Diego Healthcare System San Diego, CA, USA ; Department of Psychiatry, University of California, San Diego La Jolla, CA, USA
| | - Daniel A Nation
- Department of Psychology, University of Southern California Los Angeles, CA, USA
| | - Lindsay R Clark
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California San Diego, CA, USA
| | - Alexandrea L Harmell
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California San Diego, CA, USA
| | - Christina E Wierenga
- Department of Psychiatry, University of California, San Diego La Jolla, CA, USA ; Research Service, VA San Diego Healthcare System San Diego, CA, USA
| | - Sheena I Dev
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California San Diego, CA, USA
| | - Lisa Delano-Wood
- Department of Psychiatry, University of California, San Diego La Jolla, CA, USA ; Research Service, VA San Diego Healthcare System San Diego, CA, USA
| | - Zvinka Z Zlatar
- Department of Psychiatry, University of California, San Diego La Jolla, CA, USA
| | - David P Salmon
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Thomas T Liu
- Department of Radiology, University of California San Diego, La Jolla, CA, USA
| | - Mark W Bondi
- Psychology Service, VA San Diego Healthcare System San Diego, CA, USA ; Department of Psychiatry, University of California, San Diego La Jolla, CA, USA
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Depp CA, Harmell AL, Savla GN, Mausbach BT, Jeste DV, Palmer BW. A prospective study of the trajectories of clinical insight, affective symptoms, and cognitive ability in bipolar disorder. J Affect Disord 2014; 152-154:250-5. [PMID: 24200153 PMCID: PMC4011138 DOI: 10.1016/j.jad.2013.09.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 09/24/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Clinical insight in bipolar disorder is associated with treatment adherence and psychosocial outcome. The short-term dynamics of clinical insight in relationship to symptoms and cognitive abilities are unknown. METHODS In a prospective observational study, a total of 106 outpatients with bipolar disorder I or II were assessed at baseline, 6 weeks, 12 weeks, and 26 weeks. Participants were administered a comprehensive neuropsychological battery, clinical ratings of manic and depressive symptom severity, and self-reported clinical insight. Lagged correlations and linear mixed-effects models were used to determine the temporal associations between symptoms and insight, as well as the moderating influence of global cognitive abilities. RESULTS At baseline, insight was modestly correlated with severity of manic symptoms, but not with depressive symptoms or cognitive abilities. Insight and depressive symptoms fluctuated to approximately the same extent over time. Both lagged correlations and mixed effects models with lagged effects indicated that the severity of manic symptoms predicted worse insight at later assessments, whereas the converse was not significant. There were no direct or moderating influences of global cognitive abilities. LIMITATIONS Our sample size was modest, and included relatively psychiatrically stable outpatients, followed for a six month period. Our results may not generalize to acutely symptomatic patients followed over a longer period. CONCLUSIONS Clinical insight varies substantially over time within patients with bipolar disorder. Impaired insight in bipolar disorder is more likely to follow than to precede manic symptoms.
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Affiliation(s)
- Colin A. Depp
- Department of Psychiatry, University of California, San Diego,VA San Diego Healthcare System, VA San Diego
| | - Alexandrea L. Harmell
- Department of Psychiatry, University of California, San Diego, San Diego State University, Department of Psychology, San Diego, CA
| | | | | | - Dilip V. Jeste
- Department of Psychiatry, University of California, San Diego
| | - Barton W. Palmer
- Department of Psychiatry, University of California, San Diego,3Veterans Medical Research Foundation, VA San Diego,VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC)
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Moore RC, Harmell AL, Ho J, Patterson TL, Eyler LT, Jeste DV, Mausbach BT. Initial validation of a computerized version of the UCSD Performance-Based Skills Assessment (C-UPSA) for assessing functioning in schizophrenia. Schizophr Res 2013; 144:87-92. [PMID: 23375625 PMCID: PMC3572290 DOI: 10.1016/j.schres.2012.12.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 12/18/2012] [Accepted: 12/20/2012] [Indexed: 01/15/2023]
Abstract
OBJECTIVE This study aimed to validate the Computerized UCSD Performance-Based Skills Assessment (C-UPSA), a newly developed scale for assessing functional capacity in patients with schizophrenia. METHODS The C-UPSA was administered to 21 middle-aged and older adults with schizophrenia and 20 healthy comparison (HC) subjects. Schizophrenia participants also completed the original UPSA and a symptom inventory (during a separate visit), and cognitive functioning was assessed in both groups using a brief neuropsychological screening battery. RESULTS The C-UPSA total score was significantly correlated with UPSA total scores, and the magnitude of the correlation was comparable to the test-retest reliability of the original UPSA. The C-UPSA was also significantly correlated with UPSA-Brief scores and neuropsychological status among schizophrenia participants. Furthermore, the schizophrenia group scored significantly lower than the HCs on the C-UPSA. ROC curves were generated to determine the optimal C-UPSA value for discriminating between the two groups, with results indicating an optimal cutoff of 75, which is consistent with the derived cutoff from the original UPSA. The C-UPSA identified persons with schizophrenia with 95% accuracy. CONCLUSIONS The C-UPSA appears to be highly related to the original UPSA. It has several advantages over the standard version, including increased portability, decreased administration time, and minimized examiner impact on participant performance. Future research would benefit from establishing this test as a clinical and research tool to effectively assess functional capacity.
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Affiliation(s)
- Raeanne C. Moore
- Department of Psychiatry, University of California–San Diego, 9500 Gilman Drive, La Jolla, California, 92093 USA
- The Sam and Rose Stein Institute for Research on Aging, University of California–San Diego, 9500 Gilman Drive, La Jolla, California, 92093 USA
| | - Alexandrea L. Harmell
- Department of Psychiatry, University of California–San Diego, 9500 Gilman Drive, La Jolla, California, 92093 USA
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology, 5500 Campanile Drive, San Diego, California, 92182-4611 USA
| | - Jennifer Ho
- Department of Psychiatry, University of California–San Diego, 9500 Gilman Drive, La Jolla, California, 92093 USA
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology, 5500 Campanile Drive, San Diego, California, 92182-4611 USA
| | - Thomas L. Patterson
- Department of Psychiatry, University of California–San Diego, 9500 Gilman Drive, La Jolla, California, 92093 USA
- Correspondence concerning this article should be addressed to Thomas L. Patterson, Ph.D., Department of Psychiatry, University of California San Diego, 9500 Gilman Drive #0680; La Jolla, California, 92093-0680. . Fax: 858-534-7723
| | - Lisa T. Eyler
- Department of Psychiatry, University of California–San Diego, 9500 Gilman Drive, La Jolla, California, 92093 USA
- The Sam and Rose Stein Institute for Research on Aging, University of California–San Diego, 9500 Gilman Drive, La Jolla, California, 92093 USA
- Mental Illness Research, Education, and Clinical Center (MIRECC), VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, California, 92161 USA
| | - Dilip V. Jeste
- Department of Psychiatry, University of California–San Diego, 9500 Gilman Drive, La Jolla, California, 92093 USA
- The Sam and Rose Stein Institute for Research on Aging, University of California–San Diego, 9500 Gilman Drive, La Jolla, California, 92093 USA
| | - Brent T. Mausbach
- Department of Psychiatry, University of California–San Diego, 9500 Gilman Drive, La Jolla, California, 92093 USA
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Harmell AL, Palmer BW, Jeste DV. Preliminary study of a web-based tool for enhancing the informed consent process in schizophrenia research. Schizophr Res 2012; 141:247-50. [PMID: 22939457 PMCID: PMC3471544 DOI: 10.1016/j.schres.2012.08.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Revised: 07/28/2012] [Accepted: 08/02/2012] [Indexed: 10/27/2022]
Abstract
Printed research consent forms serve to legally document what has been disclosed, but are usually suboptimal as a means of actually communicating that information to potential participants. We conducted a preliminary study of web-based multimedia consent. Participants included 19 patients with schizophrenia and 16 normal comparison (NC) subjects randomly assigned to a routine or web-media consent. Although comprehension among NCs was excellent regardless of consent condition, the web-based consent was associated with better comprehension and satisfaction among patients with schizophrenia. Findings suggest that web-aided multimedia consent is feasible and potentially more effective than printed consent forms in schizophrenia research.
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Affiliation(s)
- Alexandrea L. Harmell
- University of California, San Diego, Department of Psychiatry, La Jolla, CA,San Diego State University, Department of Psychology, San Diego, CA
| | - Barton W. Palmer
- University of California, San Diego, Department of Psychiatry, La Jolla, CA,Stein Institute for Research on Aging, Veterans Medical Research Foundation, VASDHS, San Diego, CA
| | - Dilip V. Jeste
- University of California, San Diego, Department of Psychiatry, La Jolla, CA,Stein Institute for Research on Aging
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Depp CA, Mausbach BT, Harmell AL, Savla GN, Bowie CR, Harvey PD, Patterson TL. Meta-analysis of the association between cognitive abilities and everyday functioning in bipolar disorder. Bipolar Disord 2012; 14:217-26. [PMID: 22548895 PMCID: PMC3396289 DOI: 10.1111/j.1399-5618.2012.01011.x] [Citation(s) in RCA: 220] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Neurocognitive deficits are common in bipolar disorder and contribute to functional disability. However, the degree to which general and specific cognitive deficits affect everyday functioning in bipolar disorder is unknown. The goal of this meta-analysis was to examine the magnitude of the effect of specific neurocognitive abilities on everyday functioning in bipolar disorder. METHODS We conducted a comprehensive meta-analysis of studies that reported associations between performance on objective neuropsychological tasks and everyday functioning among individuals with bipolar disorder. From an initial pool of 486 papers, 22 studies met inclusion criteria, comprising a total of 1344 participants. Correlation coefficients were calculated for 11 cognitive domains and four measurement modalities for functioning. We also examined effect moderators, such as sample age, clinical state, and study design. RESULTS The mean Pearson correlation between neurocognitive ability and functioning was 0.27, and was significant for all cognitive domains and varied little by cognitive domain. Correlations varied by methods of everyday functioning assessment, being lower for clinician and self-report than performance-based tasks and real-world milestones such as employment. None of the moderator analyses were significant. CONCLUSIONS Overall, the strength of association between cognitive ability and everyday functioning in bipolar disorder is strikingly similar to that seen in schizophrenia, with little evidence for differences across cognitive domains. The strength of association differed to a greater extent according to functional measurement approach.
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Affiliation(s)
- Colin A. Depp
- Department of Psychiatry, University of California, San Diego
| | | | | | - Gauri N. Savla
- Department of Psychiatry, University of California, San Diego
| | | | - Philip D. Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine
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Roepke SK, Allison M, von Känel R, Mausbach BT, Chattillion EA, Harmell AL, Patterson TL, Dimsdale JE, Mills PJ, Ziegler MG, Ancoli-Israel S, Grant I. Relationship between chronic stress and carotid intima-media thickness (IMT) in elderly Alzheimer's disease caregivers. Stress 2012; 15:121-9. [PMID: 21790484 PMCID: PMC3223262 DOI: 10.3109/10253890.2011.596866] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The stress associated with providing care for a spouse diagnosed with Alzheimer's disease can have adverse effects on cardiovascular health. One potential explanation is that chronic caregiving stress may contribute to the development of atherosclerosis. The purpose of this study was to determine whether the duration that one has provided care is associated with the degree of atherosclerotic burden, as measured by carotid artery intima-media thickness (IMT). One hundred and ten Alzheimer caregivers [mean age 74 ± 8 (SD) years, 69% female] underwent in-home assessment of carotid artery IMT via B-mode ultrasonography. Data regarding medical history, blood pressure, and multiple indicators of caregiving stress were also collected. Multiple regression indicated that duration of care was positively associated with IMT measured in the internal/bifurcation segments of the carotid artery (β = 0.202, p = 0.044) independent of risk factors such as age, gender, body mass index, smoking history, sleep quality, hypertension status, and caregiving stressors. Duration of care was positively associated with IMT in the common carotid artery, but the relationship was not significant. These findings provide more evidence of the link between chronic caregiving stress and cardiovascular disease and indicate that enduring the experience of caregiving over a period of years might be associated with atherosclerotic burden.
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Affiliation(s)
- Susan K Roepke
- San Diego State University/University of California, San Diego, Joint Doctoral Program in Clinical Psychology, San Diego, CA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA
| | - Matthew Allison
- Department of Family and Preventative Medicine, University of California, San Diego, La Jolla, CA
| | - Roland von Känel
- Department of Psychiatry, University of California, San Diego, La Jolla, CA
- Department of General Internal Medicine, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Brent T Mausbach
- Department of Psychiatry, University of California, San Diego, La Jolla, CA
| | - Elizabeth A Chattillion
- San Diego State University/University of California, San Diego, Joint Doctoral Program in Clinical Psychology, San Diego, CA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA
| | | | - Thomas L Patterson
- Department of Psychiatry, University of California, San Diego, La Jolla, CA
| | - Joel E Dimsdale
- Department of Psychiatry, University of California, San Diego, La Jolla, CA
| | - Paul J Mills
- Department of Psychiatry, University of California, San Diego, La Jolla, CA
| | - Michael G Ziegler
- Department of Medicine, University of California San Diego, La Jolla, CA
| | - Sonia Ancoli-Israel
- San Diego State University/University of California, San Diego, Joint Doctoral Program in Clinical Psychology, San Diego, CA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA
| | - Igor Grant
- Department of Psychiatry, University of California, San Diego, La Jolla, CA
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Mausbach BT, Roepke SK, Chattillion EA, Harmell AL, Moore R, Romero-Moreno R, Bowie CR, Grant I. Multiple mediators of the relations between caregiving stress and depressive symptoms. Aging Ment Health 2012; 16:27-38. [PMID: 22224706 PMCID: PMC3266948 DOI: 10.1080/13607863.2011.615738] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE This study tested a model for explaining how stress is associated with depressive symptoms in a sample of spouse caregivers of patients with Alzheimer's disease. It was hypothesized that more depressive symptoms would be significantly correlated with both 'primary' caregiver stressors (i.e., care recipient problem behaviors) and 'secondary' stress (i.e., role overload), but that this relationship would be significantly mediated by four variables: (1) personal mastery, (2) coping self-efficacy, (3) activity restriction, and (4) avoidance coping. METHOD We used an asymptotic and resampling strategy for simultaneously testing multiple mediators of the stress-to-depressive symptoms pathway. RESULTS Greater stress was significantly related to more depressive symptoms. Increased stress was also associated with reduced personal mastery and self-efficacy, as well as increased activity restriction and avoidance coping. Finally, these four mediators accounted for a significant amount of the relationship between stress and depressive symptoms. DISCUSSION These results suggest multiple pathways by which both primary and secondary caregiver stresses may be associated with increased depressive symptoms, and may argue for multiple treatment targets for caregiver interventions.
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Affiliation(s)
- Brent T Mausbach
- Department of Psychiatry, University of California, San Diego, CA, USA.
| | - Susan K Roepke
- Department of Psychiatry, University of California San Diego,San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology
| | - Elizabeth A Chattillion
- Department of Psychiatry, University of California San Diego,San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology
| | | | - Raeanne Moore
- Department of Psychiatry, University of California San Diego,California School of Professional Psychology, Alliant International University, San Diego, CA
| | - Rosa Romero-Moreno
- Psychology Department. Universidad Rey Juan Carlos de Madrid. 28922 – Alcorcón – Madrid – Spain
| | | | - Igor Grant
- Department of Psychiatry, University of California San Diego
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von Känel R, Mausbach BT, Dimsdale JE, Mills PJ, Patterson TL, Ancoli-Israel S, Ziegler MG, Roepke SK, Harmell AL, Allison M, Grant I. Regular physical activity moderates cardiometabolic risk in Alzheimer's caregivers. Med Sci Sports Exerc 2011; 43:181-9. [PMID: 20473220 DOI: 10.1249/mss.0b013e3181e6d478] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Dementia caregivers have an increased risk of cardiovascular disease, and it is possible that metabolic disturbances contribute to this risk. Regular physical exercise reduces cardiometabolic risk, but caregivers may have less opportunity to engage in such activity. We hypothesized that regular physical activity would moderate cardiometabolic risk in dementia caregivers. METHODS One hundred and fifteen Alzheimer's caregivers and 54 noncaregiving controls were assessed for medical history and health habits. Physical activity was defined as the number of days per week participants performed light (score = 0-4), moderate (score = 0-4), or vigorous (score = 0-4) exercise (total score = 0-12). A cardiometabolic risk score was calculated by adding standardized z-scores of five metabolic syndrome components: body mass index, triglycerides, HDL cholesterol, systolic blood pressure, and glucose. RESULTS Caregivers were less physically active than noncaregivers (mean ± SD = 5.1 ± 3.0 vs 6.3 ± 2.7, P = 0.008). A significant caregiver status × physical activity interaction was found for the standardized cardiometabolic risk score controlling for gender, age, education, smoking, alcohol consumption, health problems, cholesterol-lowering medication, negative affect, role overload, and fasting state (P = 0.035). Among participants with low levels of physical activity, caregivers had greater cardiometabolic risk score than noncaregivers (0.58 ± 0.31 vs -1.23 ± 0.54, P = 0.017); no group difference emerged in participants with high levels of physical activity (P = 0.81). CONCLUSIONS Cardiometabolic risk was particularly high in caregivers reporting reduced levels of regular physical activity. Intervention studies aimed at increasing physical activity in caregivers seem warranted to examine whether that would possibly lower cardiometabolic risk to the level of noncaregivers.
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Affiliation(s)
- Roland von Känel
- Division of Psychosomatic Medicine, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
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Harmell AL, Mausbach BT, Roepke SK, Moore RC, von Känel R, Patterson TL, Dimsdale JE, Mills PJ, Ziegler MG, Allison MA, Ancoli-Israel S, Grant I. The relationship between self-efficacy and resting blood pressure in spousal Alzheimer's caregivers. Br J Health Psychol 2011; 16:317-28. [PMID: 21489059 DOI: 10.1348/135910710x504932] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To examine whether high levels of self-efficacy for problem-focused coping were significantly related to several resting BP measures in spousal Alzheimer's disease caregivers. DESIGN Cross-sectional. METHODS Participants included 100 older caregivers (mean age = 73.8 ± 8.14 years) providing in home care for a spouse with Alzheimer's disease. All participants completed a 13-item short form of the Coping Self-Efficacy Scale and underwent an in-home assessment where a visiting nurse took the average of three serial BP readings. Multiple regression was used to examine the relationship between self-efficacy and mean arterial pressure (MAP), systolic BP (SBP), diastolic BP (DBP), and pulse pressure (PP) after controlling for age, gender, smoking history, body mass index, the care recipient's clinical dementia rating, diabetes, alcohol use, and the use of antihypertensive medications. RESULTS Overall, high levels of self-efficacy for problem-focused coping were associated with lower MAP, SBP, and PP. Self-efficacy for problem-focused coping was marginally associated with resting DBP, but not significant. In addition, we conducted secondary analyses of the other two self-efficacy scales to explore the relationship between each dimension and MAP. We found that there were no significant relationships found between MAP and self-efficacy for stopping unpleasant thoughts/emotions or self-efficacy for getting social support. CONCLUSIONS The present study adds to the current body of literature by illustrating the possibility that higher self-efficacy can have physiological advantages, perhaps by buffering chronic stress's impact on resting BP. Another contribution of the current study is its attempt to understand the role of each individual component of self-efficacy. These findings invite future research to investigate whether caregivers might experience cardiovascular benefits from interventions aimed at enhancing self-efficacy.
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Affiliation(s)
- Alexandrea L Harmell
- Joint Doctoral Program in Clinical Psychology, University of California-San Diego/San Diego State University, CA, USA
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Roepke SK, Mausbach BT, Patterson TL, Von Känel R, Ancoli-Israel S, Harmell AL, Dimsdale JE, Aschbacher K, Mills PJ, Ziegler MG, Allison M, Grant I. Effects of Alzheimer caregiving on allostatic load. J Health Psychol 2010; 16:58-69. [PMID: 20709885 DOI: 10.1177/1359105310369188] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study aimed to determine if Alzheimer caregivers have increased allostatic load compared to non-caregivers. Potential psychological moderators (mastery, depression, and role overload) of the relationship between caregiving status and allostatic load were also explored. Eighty-seven caregivers and 43 non-caregivers underwent biological assessment of allostatic load and psychological assessments. Caregivers had significantly higher allostatic load compared to non-caregivers ( p < .05). Mastery, but not depression or overload, moderated the relationship between caregiving status and allostatic load. In conclusion, allostatic load may represent a link explaining how stress translates to downstream pathology, but more work is necessary to understand the role of psychological factors.
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Affiliation(s)
- Susan K Roepke
- San Diego State University & University of California, San Diego Joint Doctoral Program in Clinical Psychology, La Jolla, California 92093-0680, USA
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Roepke SK, Mausbach BT, von Känel R, Ancoli-Israel S, Harmell AL, Dimsdale JE, Aschbacher K, Mills PJ, Patterson TL, Grant I. The moderating role of personal mastery on the relationship between caregiving status and multiple dimensions of fatigue. Int J Geriatr Psychiatry 2009; 24:1453-62. [PMID: 19548267 PMCID: PMC4091958 DOI: 10.1002/gps.2286] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE A substantial proportion of chronically-stressed spousal dementia caregivers report fatigue. The objective of this study was to examine whether personal mastery moderates the relationship between caregiving status (caregiver/non-caregiver) and multiple dimensions of fatigue. METHODS Seventy-three elderly Alzheimer's caregivers and 41 elderly non-caregivers completed the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF) and questionnaires assessing mastery. RESULTS Regression analyses indicated that global fatigue was significantly higher for caregivers (M = 38.0 +/- 21.0) compared to non-caregivers (M = 18.2 +/- 10.4). However, personal mastery moderated the relation between caregiving status and global fatigue (t = -2.03, df = 107, p = 0.045), such that for those with low mastery, caregivers' fatigue scores were 18.1 points higher than non-caregivers, and for those with high mastery, this difference was only 7.5 points. For specific dimensions of fatigue, mastery moderated the relations between caregiving status and both emotional (t = -2.01, df = 107, p = 0.047) and physical (t = -2.51, df = 107, p = 0.014) fatigue. Specifically, association between caregiving status and emotional fatigue was greater when mastery was low than when mastery was high. Caregiving status was significantly associated with physical fatigue when mastery was low, but not when mastery was high. Significant main effects were found between mastery and general fatigue and vigor. CONCLUSION Given the proportion of fatigued caregivers and the impact fatigue has on health; these findings provide important information regarding mastery's relationship with fatigue and may inform interventions aiming to alleviate fatigue in caregivers.
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Affiliation(s)
- Susan K. Roepke
- Department of Psychiatry, University of California, San Diego
| | | | - Roland von Känel
- Department of Psychiatry, University of California, San Diego,Department of General Internal Medicine, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Sonia Ancoli-Israel
- Department of Psychiatry, University of California, San Diego,San Diego Veterans Affairs Healthcare System, La Jolla, California, USA
| | | | | | | | - Paul J. Mills
- Department of Psychiatry, University of California, San Diego
| | - Thomas L. Patterson
- Department of Psychiatry, University of California, San Diego,San Diego Veterans Affairs Healthcare System, La Jolla, California, USA
| | - Igor Grant
- Department of Psychiatry, University of California, San Diego,San Diego Veterans Affairs Healthcare System, La Jolla, California, USA
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