In a cross-sectional study, 31 dementia caregivers were compared to a group of 25 noncaregiving controls to evaluate whether the stress of being the primary caregiver of a person with dementia produces cognitive dysfunction. Cognitive differences were examined to evaluate the relationships between cognitive function and stress-related physiological and psychological measures to contribute information regarding its potential mechanism. The cognitive assessments were 2 measures of attention-executive function and 1 word list memory task. Physiological and self-rated stress-related measurements included cortisol, perceived stress, depression, self-efficacy, mindfulness, sleep quality, fatigue, and neuroticism. Caregivers performed worse than noncaregivers on the 2 attention tasks but not on the word list memory test. There was no interaction of caregiver status and age on cognitive performance. The caregivers and noncaregivers differed in morning salivary cortisol and most of the self-rated stress-related measures with the caregiver values reflecting greater stress. Of note, impaired sleep was the only potential mediator of the caregiver effect on cognitive performance in our small sample.
PinquartMSorensonS. Differences between careivers and noncaregivers in psychological health and physical health: a meta-analysis. Psychol Aging. 2003;18(2):250–267.
3.
PinquartMSorensonS. Correlates of physical health of informal caregivers: a meta-analysis. J Gerontol B Psychol Sci Soc Sci. 2007;62B(2):P126–P137.
4.
BaumgartenMHanleyJAInfante-RivardCBattistaRNBeckerRGauthierS.Health of family members caring for elderly persons with dementia. a longitudinal study. Ann Intern Med. 1994;120(2):126–132.
5.
SchulzRO'BrienABookwalaJFleissnerK. Psychiatric and physical morbidity effects of dementia caregiving: prevalence, correlates, and causes. Gerontologist. 1995;35(6):771–191.
6.
VitalianoPPZhangJYoungHMCaswellLWScanlanJMEcheverriaD. Depressed mood mediates decline in cognitive processing speed in caregivers. Gerontologist. 2009;49(1):12–22.
7.
MillerLSLewisMSWilliamsonGM. Caregiver cognitive status and potentially harmful caregiver behavior. Aging Ment Health. 2006;10(2):125–133.
8.
De VugtMEJollesJva OschL. Cognitive functioning in spousal caregivers of dementia patients: findings from the prospective MAASBED study. Age Ageing. 2006;35(2):160–166.
9.
NortonMCSmithKROstbyeT. Greater risk of dementia when spouse has dementia? the cache county study. J Am Geriatr Soc. 2010;58(5):895–900.
JoyntKEWhellanDJO'ConnorCM. Depression and cardiovascular disease: mechanisms of interaction. Biol Psychiatry2003;54(3):248–261.
12.
VitalianoPPScanlanJMZhangJSavageMVHirschIBSieglerIC. A path model of chronic stress, the metabolic syndrome, and coronary heart disease. Psychosom Med. 2002;64(3):418–435.
13.
McEwenBS. The neurobiology of stress: from serendipity to clinical relevance. Brain Res. 2000;886(1-2):172–189.
14.
LupienSJNairNPVBriereS. Increased cortisol levels and impaired cognition in human aging: implication for depression and dementia later in life. Rev Neurosci. 1999;10(2):117–139.
15.
SapolskyRM. Glucocorticoids, stress, and their adverse neurological effects: relevance to aging. Exp Gerontol. 1999;34(6):721–732.
16.
McEwenBSWingfieldJC. The concept of allostasis in biology and biomedicine. Horm Behav. 2003;43(1):2–15.
17.
LupienSLMcEwenBSGunnarMRHeimC. Effects of stress throughout the lifespan on the brain, behavior and cognition. Nat Rev Neurosci. 2009;10(6):434–445.
18.
StawskiRSSliwinskiMJSmythJM. Stress-related cognitive interference predicts cognitive function in old age. Psychol Aging. 2006;21(3):535–544.
19.
LupienSJFioccoAWanN. Stress hormones and human memory function across the lifespan. Psychoneuroendocrinology. 2005;30(3):225–242.
20.
AlbertMSSavageCRBlazerD. Predictors of cognitive change in older persons: MacArthur studies of successful aging. Psychol Aging. 1995;10(4):578–589.
21.
BirrenJESchaieKW, eds. Handbook of the Psychology of Aging. 6th ed. Amsterdam: Elsevier; 2006.
22.
CaswellLWVitalianoPPCroyleKLScanlanJMZhangJDaruwalaA. Negative associations of chronic stress and cognitive performance in older adult spouse caregivers. Exp Aging Res. 2003;29(3):303–318.
23.
LeeSKawachiIGrodsteinF. Does caregiving stress affect cognitive function in older women. J Nev Ment Dis. 2004;192(1):51–57.
24.
VitalianoPPYiJPhillipsEMEscheverriaDYoungH. Psychophysiological mediators of caregiver stress and differential cognitive decline. Psychol Aging. 2005;20(3):402–411.
25.
MarzialiEMcClearyLStreinerDL. Evaluation of an assessment battery for estimating dementia caregiver needs for health and social care service. Am J Alzheimer's Dis Other Demen. 2010;25(5):446–454.
26.
SmithBWShelleyBMDalenJWigginsKTooleyEBernardJ. A pilot study comparing the effects of mindfulness-based and cognitive-behavioral stress reduction. J Altern Complement Med. 2008;14(3):251–258.
27.
OkenBSFonarevaIHaasM. Pilot controlled trial of mindfulness meditation and education for dementia caregivers. J Altern Complement Med. 2010;16(10):1031–1038.
28.
WelshKABreitnerJCSMagruder-HabibKM. Detection of dementia in the elderly using telephone screning of cognitive status. Neuropsychiatr Neuropsychol Behav Neurol. 1993;6(2):103–110.
29.
RadloffL. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychological Meas. 1977;1:385–401.
30.
CohenSKarmarckTMermelsteinR. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385–396.
31.
WareJF. SF-36 Health Survey: Manual Interpretation Guide. Boston, MA: The Health Institute; 1993.
32.
OkenBSZajdelDKishiyamaS. Randomized controlled 6-month trial of yoga in healthy seniors. Altern Ther Health Med. 2006;12(1):40–47.
33.
FisherPALaschingerHS. A relaxation training program to increase self-efficacy for anxiety control in Alzheimer family caregivers. Holist Nurs Pract. 2001;15(2):47–58.
34.
MausbachBTvon KanelRRoepkeSK. Self-efficacy buffers the relationship between dementia caregiving stress and circulating concentratations of the proinflmamatory cytokine interleukin-6. Am J Geriatr Psychiatry. 2011;19(1):64–71.
35.
SchwarzerRJerusalemM. Generalized self-efficacy scale. In: WeinmanJWrightSJohnstonM, eds. Measures in Health Psychology: A User's Portfolio. Causal and Control Beliefs. Windsor, UK: Nfer-Nelson; 1995:35–37.
36.
BaerRASmithGTAllenKB. Assessment of mindfulness by self-report: the Kentucky inventory of mindfulness skills. Assessment. 2004;11(3):191–206.
37.
BaerRASmithGTHopkinsJKrietmeyerJToneyL. Using self-report assessment methods to explore facets of mindfulness. Assessment. 2006;13(1):27–45.
38.
BuyseDJReynoldsCFMonkTHBermanSRKupferDJ. The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatr Res. 1989;28(2):192–213.
39.
MillsPJAncoli-IsraelSvon KanelR. Effects of gender and dementia severity on Alzheimer's disease caregivers' sleep and biomarkers of coagulation and inflammation. Brain Behav Immun. 2009;23(5):605–610.
40.
FonarevaIAmenAZajdelDEllingsonROkenB. Assessing sleep architecture in dementia caregivers at home using an ambulatory polysomnographic system. J Geriatr Psychiatry Neurol. 2011;24(1):50–59.
De VugtMENicolsonNAAaltenPLousbergRJolleJVerheyFRJ. Behavioral problems in dementia patients and salivary cortisol patterns in caregivers. J Neuropsychiatry Clin Neurosci. 2005;17(2):201–207.
43.
WahbehHKishiyamaSZajdelDOkenB. Salivary cortisol awakening response in mild Alzheimer's disease, caregivers, and non-caregivers. Alzheimer Dis Related Disord. 2008;22(2):181–183.
44.
WilkinsonGS. Wide Range Achievement Test-Revision 3 Administration Manual. Wilmington, DE: Wide Range, Inc; 1993
45.
PfefferRIKurosakiTTHarrahCHChanceJMFilosS. Measurement of functional activities in older adults in the community. J Gerontol. 1982;37(3):323–329.
46.
PerretE. The left frontal lobe of man and the suppression of habitual responses in verbal categorical behavior. Neuropsychologia. 1974;12(3):323–330.
47.
FanJMcCandlissBDSommerTRazAPosnerMI. Testing the efficiency and independence of attentional networks. J Cogn Neurosci. 2002;14(3):340–347.
48.
MorrisJHeymanAMohsR. The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) Part 1. Clinical and neuropsychological assessment of Alzheimer's disease. Neurology. 1989;39(9):1159–1165.
49.
WahbehHLuMOkenB. Mindful awareness and non-judging in relation to posttraumatic stress disorder symptoms. Mindfulness. In press.
50.
MackenzieCSSmithMCHasherLLeachLBehlP. Cognitive functioning under stress: evidence from informal caregivers of palliative patients. J Palliat Med. 2007;10(3):749–758.
51.
RoweMAMcCraeSSCampbellJMBenitoAPChengJ. Sleep pattern differences between older adult dementia caregivers and older adult noncaregivers using objective and subjective measures. J Clin Sleep Med. 2008;4(4):362–269.
52.
MillsPJAncoli-IsraelSVon KanelR. Effects of gender and dementia severity on Alzheimer's disease caregivers' sleep and biomarkers of coagulation and inflammation. Brain Behav Immun. 2009;23(5):605–610.
53.
DurmerJSDingesDF. Neurocognitive consequences of sleep deprivation. Semin Neurol. 2005;25(1):117–129.
54.
OkenBSSalinskyMCElsasSM. Vigilance, alertness, or sustained attention: physiological basis and measurement. Clin Neurophysiol. 2006;117(9):1885–1901.
55.
MohamedSRosenheckRLyketsosCGSchneiderLS. Caregiver burden in Alzheimer disease: cross-sectional and longitudinal patient correlates. Am J Geriatr Psychiatry. 2010;18(10):917–927.
56.
MackenzieCSWiprzyckaUJHasherLGoldsteinD. Associations between psychological distress, learning, and memory in spouse caregivers of older adults. J Gerontol B Psychol Sci Soc Sci. 2009;64(6):742–746.
57.
WilsonRSEvansDABieniasJLMendes De LeonCFSchneiderJABennettDA. Proneness to psychological distress is associated with risk of Alzheimer's disease. Neurology. 2003;61(11):1479–1485.
58.
DevanandDPSanoMTangMX. Depressed mood and the incidence of Alzheimer's disease in the elderly living in the community. Arch Gen Psychiatry. 1996;53(2):175–182.
59.
Aguera-OrtizLFrank-GarciaAGilPMorenoA. Clinical progression of moderate-to-severe Alzheimer's disease and caregiver burden: a 12-month multicenter prospective observational study. Int Psychogeriatr. 2010;22(8):1265–1279.
60.
FonarevaIAmenAEllisonRGOkenB. Differences in stress-related ratings between research center and home environments in dementia caregivers using ecological momentary assessment. Int Psychogeriatr. 2011:1–9.
