A Cognitive Psychophysiological Model to Predict Functional Decline in Chronically Stressed Older Adults

The current study evaluated whether psychological distress (composite of depression, anxiety, vital exhaustion), inflammation (C-reactive protein, CRP) and cognitive function (Digit Symbol Test, DST) and their changes mediated the relationship between caregiver status and functional decline. Caregivers for spouses with Alzheimer’s disease were compared to demographically-similar non-caregiver spouses at study entry (T1), T2 (1 year later), and T3 (2 years after T1). Caregivers had greater functional impairment, higher distress scores, and poorer DST scores at all points of measurement and also showed functional decline. Non-caregivers did not demonstrate functional decline. Caregivers declined 85% faster than did non-caregivers. Regressions showed that after controlling for functional impairment at T1, illness, medication, and health behavior covariates, psychological distress at T1 and increases in CRP from T1 to T3 mediated the difference in functional decline. Moreover, after DST decline from T1 to T2 was entered in the model, caregiver status, psychological distress and increases in inflammation all showed reductions in their predictive importance. These findings suggest psychological distress and increases in inflammation may help explain why caregivers show greater functional decline than non-caregivers. However, the influences of these psychophysiological variables may be driven in part by cognitive decline prior to functional decline. This article is based upon an invited address, “Potential Hazards of Caring for a Loved One with Alzheimer’s Disease” given by the first author in recognition of the author’s receipt of the Association of Psychologists in Academic Health Centers 2005 Award for Distinguished Achievement in Research. The address was presented at the Annual meeting of the American Psychological Association, New Orleans, LA., August, 2006.     

Relationship between nicotinic receptors and cognitive function in early Alzheimer's disease: a 2-[18F]fluoro-A-85380 PET study

Neuronal nicotinic acetylcholine receptors (nAChRs) are critical for higher order cognitive processes. Post-mortem studies suggest reductions in nAChRs (particularly the alpha(4)beta(2) subtype) with ageing and in Alzheimer's disease (AD). This study aimed to; (1) quantify nAChR distribution in vivo with 2-[18F]fluoro-A-85380 (2-FA) in 15 early AD patients compared to 14 age-matched, healthy controls (HC) and (2) correlate nAChR distribution with cognitive performance in both groups. All participants were non-smokers and underwent cognitive testing along with a dynamic PET scan after injection of 200 MBq of 2-FA. Brain regional 2-FA binding was assessed through a simplified estimation of Distribution Volume (DV(S)). The AD group differed significantly from HC on all cognitive measures employed, with impairments on measures of attention, working memory, language, executive function, visuospatial ability, verbal learning and verbal memory (p<.05). Contrary to post-mortem data this study found no evidence of in vivo nAChR loss in early AD despite significant cognitive impairment. Furthermore, no correlation between nAChR and cognitive performance was found for either group. The findings of the current study suggest preservation of nAChRs early in AD supporting previous studies. It is possible that while the clinical 2-FA PET method described here may be insensitive in detecting changes in early AD, such changes may be detected in more advanced stages of the illness.     

Declarative verbal memory impairments in middle-aged women who are caregivers of offspring with autism spectrum disorders: The role of negative affect and testosterone

Caring for offspring diagnosed with a chronic psychological disorder such as autism spectrum disorder (ASD) is used in research as a model of chronic stress. This chronic stress has been reported to have deleterious effects on caregivers' cognition, particularly in verbal declarative memory. Moreover, such cognitive decline may be mediated by testosterone (T) levels and negative affect, understood as depressive mood together with high anxiety and anger. This study aimed to compare declarative memory function in middle-aged women who were caregivers for individuals with ASD (n = 24; mean age = 45) and female controls (n = 22; mean age = 45), using a standardised memory test (Rey's Auditory Verbal Learning Test). It also sought to examine the role of care recipient characteristics, negative mood and T levels in memory impairments. ASD caregivers were highly sensitive to proactive interference and verbal forgetting. In addition, they had higher negative affect and T levels, both of which have been associated with poorer verbal memory performance. Moreover, the number of years of caregiving affected memory performance and negative affect, especially, in terms of anger feelings. On the other hand, T levels in caregivers had a curvilinear relationship with verbal memory performance; that is, increases in T were associated with improvements in verbal memory performance up to a certain point, but subsequently, memory performance decreased with increasing T. Chronic stress may produce disturbances in mood and hormonal levels, which in turn might increase the likelihood of developing declarative memory impairments although caregivers do not show a generalised decline in memory. These findings should be taken into account for understanding the impact of cognitive impairments on the ability to provide optimal caregiving.     

Linguistic Analysis of Written Narratives of Caregivers of Children and Adolescents with Chronic Illness: Cognitive and Emotional Processes and Physical and Psychological Health Outcomes

Used linguistic analysis of written narratives of caregivers of hospitalized youth with chronic illness to identify emotional and cognitive processes related to physical and psychological health outcomes following writing. Measures were administered at baseline and 4 months. Experimental group (n = 29) wrote about traumas whereas the control group (n = 24) wrote about summer activities for 20 min on three different days. Compared groups on negative emotion- and cognition-related word use. Tested change in negative emotion- and cognition-related word use as predictors of outcomes in experimental group. Consistent with hypotheses, experimental group used more negative emotion words [F(1, 53) = 77.55, p < .001] and cognition-related words than control group [F(1, 53) = 19.09, p < .001] and an increase in cognition words predicted Physical Health Summary Score on SF-36 (standardized = .37, p < .05). A decrease in negative emotion words was related to Physical Health Summary Score on SF-36 only when entered into regression with change in cognition words (standardized = –.31, p < .05). A decrease in negative emotion together with an increase in cognitive processing facilitated by written emotional disclosure has beneficial effects on physical health-related quality of life.     

The Importance of Emotional Intelligence and Cognitive Style in Institutionalized Older Adults' Quality of Life

Despite previous evidence showing a positive relationship between emotional intelligence (EI) and quality of life (QoL), associating older adults' emotional processing with several health indicators, few studies have explored both the IE and the a mechanisms through which they affect QoL. This cross-sectional study analyzes the mediator role of optimistic and pessimistic cognitive styles in the relationship between perceived EI (PEI) and QoL in 115 institutionalized older adults from Southern Spain. Regression analyses showed, after controlling for cognitive style, that PEI predicted a significant percentage of variance in: Health (β = .25, p < .01), Functional abilities (β = .20, p < .05), Activity and leisure (β = .17, p < .05) and Life satisfaction (β = .21, p < .05). Additionally, multiple mediation analysis revealed that cognitive style partially mediated the relationship between PEI and Health, Activity and leisure and Life satisfaction. Thus, PEI could promote personal but not external or environmental QoL aspects, highlighting the importance of developing emotional skills for healthy aging.     

How are Strouhal number, drag, and efficiency adjusted in high level underwater monofin-swimming?

Strouhal number (St) corresponds to a wake parameter based on the tail kinematics of swimming animals according to St=A.f/U, where f is the stroke frequency, A is the fin-beat peak-to-peak amplitude, and U is the forward speed. St number is a trade-off between amplitude and frequency that generates a forward velocity. This parameter may therefore be affected by swimming technique, which can be evaluated through active drag (AD) and Froude efficiency (eta(F)). The aim of our study was therefore to (1) investigate the range of AD and eta(F) values for high level monofin-swimmers, (2) explore the range of St numbers, and (3) examine to what extent this latter non-dimensional parameter may affect AD and eta(F). To this end, experiments have been conducted on 12 international level monofin-swimmers. St number, eta(F) (calculated according to the elongated-body theory), and AD (computed with velocity perturbation method) were calculated at the same time for an underwater fin-swimming trial, at maximal speed. Lowest values of St numbers (St=0.34) corresponded to fin-swimmers with highest velocities (R=-.77, p<.05), highest efficiencies (R=-.86, p<.001), and lowest active drag (R=.91, p<.001). On the one hand, AD was increased with vertical motion of the fin (R=.84, p<.001), which increased cross-sectional area (R=.78, p<.05). On the other hand, efficiencies showed a tendency to peak at eta(F)=0.82 in a narrow range of St numbers close to 0.4. This St range corresponded to the upper limit of the 0.25-0.4 range usually claimed for maximum efficiency of marine and flying animals. Such results suggest that increasing efficiency and reducing drag improves performance per se (regardless how these parameters are related with St number).     

Factor structure of patient and caregiver ratings on the dementia quality of life instrument

Preliminary evidence suggests that quality of life reports from patients diagnosed with mild cognitive impairment (MCI) and mild Alzheimer's disease (AD) are as reliable and valid as data provided by caregivers. To date, no studies compared the factor structure of data provided by caregivers and patients. Factor analyses are important to conduct because they are an indicator of validity. This study compared the factor structure of patient and caregiver reports on the Dementia Quality of Life scale (DQoL). Participants (N=67) were patients diagnosed with amnestic MCI or mild AD and their caregivers. Principal axis factor analyses were run separately on patient and caregiver report data. The three-factor solutions for patient and caregiver data were nearly identical. Three factors corresponding to positive affect, negative affect, and aesthetics emerged reliably from analyses. Thus, data from patients demonstrated a factor structure that was highly consistent with caregiver report data and conformed to meaningful psychological constructs.     

Goal Achievement and Goal-Related Cognitions in Behavioral Activation Treatment for Depression

This study investigates the extent to which achieving goals during behavioral activation (BA) treatment predicts depressive symptom improvement, and whether goal-related cognitions predict goal achievement or treatment response. Patients (n = 110, mean age 37.6, 54% female) received low-intensity cognitive behavioral therapy for depression, which included setting up to three behavioral goals in each of three BA-focused sessions (i.e., 9 goals per patient). Patients completed items from the Self-Regulation Skills Battery to assess goal-related cognitions and goal achievement for these goals, and depressive symptoms were assessed weekly with the PHQ-9. Multilevel models investigated the relationships between goal-related cognitions, goal achievement and depressive symptoms. Depressive symptoms improved curve-linearly during treatment (B = 0.12, p < .001), but were not predicted by contemporaneous or time-lagged goal achievement. While cumulative goal achievement predicted end-of-treatment depressive symptoms (r = -.23; p < .01), this relationship became nonsignificant after controlling for depressive symptoms at baseline. Readiness, planning and action control predicted greater goal achievement, whereas greater goal ownership predicted less goal achievement (all p < .05). Motivation and outcome expectancy were related to subsequent, but not contemporaneous, improvements in depressive symptoms (all p < .05). This study indicates the importance of goal-related cognitions in BA treatments, and future research should investigate potential moderators of the relationships between goal-related cognitions, goal achievement, and improvements in depressive symptoms.     

Atrophy of the parietal lobe in preclinical dementia

Cortical grey matter atrophy patterns have been reported in healthy ageing and Alzheimer disease (AD), but less consistently in the parietal regions of the brain. We investigated cortical grey matter volume patterns in parietal areas. The grey matter of the somatosensory cortex, superior and inferior parietal lobule was measured in 75 older adults (38 cognitively stable and 37 individuals with cognitive decline after 3 years). Dementia screening 6 years after scanning resulted in nine AD cases from the cognitively stable (n=3) and cognitive decline group (n=6), who were assigned to a third group, the preclinical AD group. When regional differences in cortical volume in the parietal lobe areas were compared between groups, significant differences were found between either the cognitive decline or stable group on the one hand and preclinical AD individuals on the other hand in the inferior parietal lobule. Group membership was best predicted by the grey matter volume of the inferior parietal lobule, compared to the other parietal lobe areas. The parietal lobe was characterised by a differential atrophy pattern based on cognitive status, which is in agreement with the 'last-developed-first-atrophied' principle. Future studies should investigate the surplus value of the inferior parietal lobe as a potential marker for the diagnosis of AD compared to other brain regions, such as the medial temporal lobe and the prefrontal lobe.     

Response Expectancies and Irrational Beliefs Predict Exam-Related Distress

Individual differences in cognitive factors such as response expectancies and irrational beliefs (IBs) have been shown to contribute to variability in distress associated with stressful situations. However, their independent influence on distress when examined within the same study has not been established, nor has the potential of mediational relationships. The purpose of this study was to investigate the contribution of response expectancies and IBs (both general and exam-specific) to exam-related distress in a prospective study. Results revealed that both response expectancies and general IBs separately predicted exam-related distress (p’s<.05; N=105). Observed effects of general IBs were perfectly mediated by, and observed effects of exam-specific IBs were partially mediated by, response expectancies using the Baron and Kenny approach. These data support the view that cognitive factors contribute to psychological distress and are consistent with response expectancy and rational emotive behavior theories. The results suggest that interventions focused on response expectancies and IBs might be an effective means to reduce psychological distress associated with real life stressors such as exams. Future research is needed to determine whether this effect generalizes to other stressful situations. Dr. Montgomery is Director of the Integrative Behavioral Medicine Program at the Mount Sinai School of Medicine. Dr. David is an associate professor at Babes-Bolyai University, in Romania. Dr. DiLorenzo is an assistant professor in the Psychology Department of Stern College. Dr. Schnur is a postdoctoral fellow in the Department of Oncological Sciences at Mount Sinai School of Medicine. This work was supported by the National Cancer Institute (CA81137) and the American Cancer Society (PF-05-098-01-CPPB).     

Chronic Sorrow in Caregiving Spouses of Patients with Alzheimer's Disease

The article focuses on the concept of chronic sorrow in a sample of individuals with Alzheimer's disease (AD) and their caregiving spouses. A study was designed to determine the long-term grief or chronic sorrow that develops in caregiving spouses and to increase knowledge of the nature of chronic sorrow. Utilizing the Burke Nursing Consortium for Research on Chronic Sorrow questionnaire and Lindgren's (1996) study as a prototype, the author discovered that repetitive feelings of sorrow and distress appear in caregivers when major disruptive changes occur in their lives due to the persistent demands caused by the illness. Continual coping skills are needed to keep caregivers from being mentally, emotionally, and physically depleted. The findings of this study are consistent with Lindgren's 1996 study of chronic sorrow in persons with Parkinson's disease.     

Relationship Between Family Dynamics of Caregivers, Depression, and the Likelihood of Institutionalization of Alzheimer's Patients

This study examined the relationship between family dynamics (as measured by the Family Adaptability and Cohesion Evaluation Scale-FACES III), depression, feelings of burden and institutionalization in spouse caregivers (N = 197) of Alzheimer's Disease (AD) patients. All data was previously collected at the New York University Medical Center's Aging and Dementia Research Center between 1987 and 1991. Although no significant results were found between family dynamics and the likelihood of institutionalization, a post-hoc analyses found that AD spouse caregivers with higher scores on family cohesion experienced significantly less burden and depression than caregivers with lower cohesion scores. Implications for future research examining family cohesion, depression, and feelings of burden in AD spouse caregivers are discussed.     

Factor Structure of Patient and Caregiver Ratings on the Dementia Quality of Life Instrument

ABSTRACT

Preliminary evidence suggests that quality of life reports from patients diagnosed with mild cognitive impairment (MCI) and mild Alzheimer's disease (AD) are as reliable and valid as data provided by caregivers. To date, no studies compared the factor structure of data provided by caregivers and patients. Factor analyses are important to conduct because they are an indicator of validity. This study compared the factor structure of patient and caregiver reports on the Dementia Quality of Life scale (DQoL). Participants (N?=?67) were patients diagnosed with amnestic MCI or mild AD and their caregivers. Principal axis factor analyses were run separately on patient and caregiver report data. The three-factor solutions for patient and caregiver data were nearly identical. Three factors corresponding to positive affect, negative affect, and aesthetics emerged reliably from analyses. Thus, data from patients demonstrated a factor structure that was highly consistent with caregiver report data and conformed to meaningful psychological constructs.     

Long-term concentrative meditation and cognitive performance among older adults

ABSTRACT

Background: The general consensus that cognitive abilities decline with advancing age is supported by several studies that have reported that older adults perform more poorly on multiple tests of cognitive performance as compared to younger adults. To date, preventive measures against this cognitive decline have been mainly focused on dietary, physical, and lifestyle behaviors which could allow older adults to maintain their cognitive abilities into late life. However, much less stress has been laid on evaluating meditation as a preventive measure in such cases in spite of the fact that the role of meditation on attention has been proved in several studies. In the current study, we extend this preliminary idea, examining the practice of concentrative meditation and the differences in the cognitive performance of older adults who have or have not employed this practice long term. Methodology: This was a cross-sectional study comparing the cognitive performance of meditators and non-meditators in the geriatric age group. Twenty (age > 55 years) long-term practitioners of Vihangam Yoga meditation (>10 years of practice) were recruited in the present study and were applied six paper–pencil neuropsychological tests for assessment of short-term memory, perceptual speed, attention, and executive functioning. The tests used were: (1) the Digit Span test, (2) the Stroop Color Word test, (3) the Trailmaking test, (4) the Letter Cancellation Task, (5) the digit symbol substitution test, and (6) the Rule Shift Card Test. All the tests were also applied to 20 age- and education-matched geriatric adults who have not practiced the meditation technique. Results: Vihangam Yogis showed significantly better performances in all these tests of attention (p < .05) except for the digit backward test, where a trend (p = .08) was found in favor of meditators. Conclusion: Long-term Vihangam Yoga meditators have superior cognitive abilities than non-meditators in the old age group. This technique should be studied further for its ability to prevent age-related cognitive decline.     

"I know what I like": stability of aesthetic preference in Alzheimer's patients

Two studies explored the stability of art preference in patients with Alzheimer's disease and age-matched control participants. Preferences for three different styles of paintings, displayed on art postcards, were examined over two sessions. Preference for specific paintings differed among individuals but AD and non-AD groups maintained about the same stability in terms of preference judgments across two weeks, even though the AD patients did not have explicit memory for the paintings. We conclude that aesthetic responses can be preserved in the face of cognitive decline. This should encourage caregivers and family to engage in arts appreciation activities with patients, and reinforces the validity of a preference response as a dependent measure in testing paradigms.     

Dyadic processes of relational turbulence theory

This study tested dyadic processes of relational turbulence theory (RTT) in heterosexual marriages. We tested propositions 1, 2, and 5 of RTT, which propose that uncertainty about the marriage biases cognitive appraisals, and that interference from a partner heightens negative emotions, both of which culminate in relational turbulence for spouses. Guided by these propositions, husbands' and wives' (N = 510; 255 marital dyads) dyadic cognitive and emotional processes were estimated using the actor-partner interdependence mediation model. Consistent with theoretical propositions, we found evidence for actor-actor indirect effects; for both husbands and wives (a) the effect of spouses' relationship uncertainty on their own relational turbulence was mediated by their own biased cognitive appraisals, and (b) the effect of spouses' experienced interference on their own relational turbulence was mediated by their own anger from communicating in the marriage. However, controlling for actor-actor indirect effects, partner-defined processes (i.e., actor-partner and partner-actor indirect effects) uniquely explained husbands' and wives' relational turbulence.     

Relationship quality and potentially harmful behaviors by spousal caregivers: how we were then, how we are now. The Family Relationships in Late Life Project

Structured interview data from 142 caregivers (98 wives, 44 husbands) indicate that more depressed caregivers are more likely to treat their spouses in potentially harmful ways. However, consistent with hypotheses derived from communal relationships theory, when the preillness relationship between caregiver and care recipient was characterized by mutual responsiveness to each other's needs (i.e., was more communal), caregivers were less depressed and less frequently engaged in potentially harmful behaviors. These effects were not attributable to demographic factors, amount of care provided, care recipient dementia status, or length of time in the caregiving role. Rather, multivariate analyses suggest that the extent to which premorbid relationships were communal in nature determines whether caregivers perceive their current relationships as rewarding, which, in turn, predicts caregiver depression and potentially harmful behaviors.     

The Children’s Attention-Deficit Hyperactivity Disorder Telemental Health Treatment Study: Caregiver Outcomes

The Children’s Attention-deficit Hyperactivity Disorder (ADHD) Telemental Health Treatment Study (CATTS) tested the hypotheses that children and caregivers who received guideline-based treatment delivered through a hybrid telehealth service delivery model would experience greater improvements in outcomes than children and caregivers receiving treatment via a comparison delivery model. Here, we present caregiver outcomes. 88 primary care providers (PCPs) in seven geographically underserved communities referred 223 children (ages 5.5 ? 12.9 years) to the randomized controlled trial. Over 22 weeks, children randomized to the CATTS service delivery model received six sessions of telepsychiatry and six sessions of caregiver behavior management training provided in person by community therapists who were trained and supervised remotely. Children randomized to the comparison Augmented Primary Care (APC) service model received management in primary care augmented by a single telepsychiatry consultation. Caregiver outcomes included changes in distress, as measured by the Patient Health Questionnaire (PHQ-9), Parenting Stress Index (PSI), Caregiver Strain Questionnaire (CSQ) and Family Empowerment Scale (FES). Caregivers completed five assessments. Multilevel mixed effects regression modeling tested for differences between the two service delivery models in caregiver outcomes from baseline to 25 weeks. Compared to caregivers of children in the APC model, caregivers of children in the CATTS service model showed statistically significantly greater improvements on the PHQ-9 (β?=?-1.41, 95 % CI?=?[?2.74, ?0.08], p?<?.05), PSI (β?=??4.59, 95 % CI?=?[?7.87, ? 1.31], p?<?.001), CSQ (β?=??5.41, 95 % CI?=?[? 8.58, ?2.24], p?<?.001) and FES (β?=?6.69, 95 % CI?=?[2.32, 11.06], p?<?.01). Improvement in child ADHD symptoms mediated improved caregiver scores on the PSI and CSQ. Improvement in child ODD behaviors mediated caregiver CSQ scores. The CATTS trial supports the effectiveness of a hybrid telehealth service delivery model for reducing distress in caregivers of children with ADHD and suggests a mechanism through which the service model affected caregiver distress.     

Antenatal depressive symptoms are strongly predicted by the severity of pre-menstrual syndrome: results of partial least squares analysis

Background/Objective: Antenatal depression (AD) is the commonest morbidity during pregnancy. There is evidence that premenstrual syndrome (PMS) and AD share common immune-inflammatory and sex hormonal pathways. This study aims to evaluate the association between the severity of depressive PMS and AD in early and late pregnancy. Method: Participants were followed from early (<=16 weeks) to late pregnancy (>=20 weeks). The Premenstrual Symptoms Screening Tool (PSST) was used to assess PMS and AD symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS). Results: Up to 57.6% of the variance in the early EPDS score was explained by the regression on the first factor extracted from 10 depression and anxiety PSST items (dubbed the DepAnx PSST), insomnia PSST, relation dissatisfaction, and partner abuse. There were specific indirect effects of DepAnx PSST (p < 0.001), insomnia PSST (p = 0.041), relation dissatisfaction (p = 0.023) and partner abuse (p = 0.007) on the late EPDS which were mediated by the early EPDS score. Conclusion: The affective, but not psychosomatic, symptoms of PMS strongly predict AD symptoms suggesting that the pathophysiology of affective PMS symptoms overlap with those of AD.     

Authenticity as a Mediator of the Relation Between Child Maltreatment and Negative Outcomes for College Women

The goal of this cross-sectional study was to determine if authenticity in relationships mediated the relation between early childhood maltreatment and negative outcomes (depression, low self-esteem, and traumatic symptoms). An ethnically diverse sample of female college students (N = 257, M age = 19.74) completed self-report questionnaires related to early childhood maltreatment, negative outcomes, and authenticity in relationships. Approximately 30% of participants experienced childhood maltreatment including physical maltreatment, emotional maltreatment, or both. Results from multiple mediation analyses indicated that, when controlling for physical maltreatment, authenticity in close relationships significantly partially mediated the relation between emotional maltreatment and depression, self-esteem, and traumatic symptoms (p < .05). However, when controlling for emotional maltreatment, physical maltreatment did not significantly predict any of the outcome variables, so physical maltreatment was not significantly mediated by authenticity in relationships. These results have important clinical implications for women who experience negative mental health outcomes as a result of childhood maltreatment.