Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-25T05:33:59.008Z Has data issue: false hasContentIssue false
  • English
  • Français

Cognitive reserve and self-efficacy as moderators of the relationship between stress exposure and executive functioning among spousal dementia caregivers

Published online by Cambridge University Press:  09 January 2017

M. M. Pertl Open the ORCID record for M. M. Pertl [Opens in a new window] ,
C. Hannigan ,
S. Brennan ,
I. H. Robertson  and
B. A. Lawlor
M. M. Pertl*
Affiliation:
Neuro-Enhancement for Independent Lives (NEIL) Programme, Trinity College Institute of Neuroscience (TCIN), Trinity College Dublin, Dublin 2, Ireland Royal College of Surgeons in Ireland, Dublin 2, Ireland
C. Hannigan
Affiliation:
Neuro-Enhancement for Independent Lives (NEIL) Programme, Trinity College Institute of Neuroscience (TCIN), Trinity College Dublin, Dublin 2, Ireland
S. Brennan
Affiliation:
Neuro-Enhancement for Independent Lives (NEIL) Programme, Trinity College Institute of Neuroscience (TCIN), Trinity College Dublin, Dublin 2, Ireland
I. H. Robertson
Affiliation:
Neuro-Enhancement for Independent Lives (NEIL) Programme, Trinity College Institute of Neuroscience (TCIN), Trinity College Dublin, Dublin 2, Ireland
B. A. Lawlor
Affiliation:
Neuro-Enhancement for Independent Lives (NEIL) Programme, Trinity College Institute of Neuroscience (TCIN), Trinity College Dublin, Dublin 2, Ireland
*
Correspondence should be addressed to: M. M. Pertl, Neuro-Enhancement for Independent Lives (NEIL) Programme, Trinity College Institute of Neuroscience (TCIN), Trinity College Dublin, Dublin 2, Ireland. Email: [email protected].
Get access

Abstract

Background:

A substantial literature has reported that stress negatively impacts on cognitive processes. As dementia caregiving can be stressful, it has been hypothesized that the challenges of dementia care may increase caregivers’ own vulnerability to cognitive decline. Prefrontal processes are thought to be most vulnerable to stress; however, few studies have examined whether greater caregiver stress predicts poorer executive dysfunction, and no previous research has considered potential moderators of this relationship. We examined (1) whether greater psychological stress mediated a relationship between caregiver stress exposure and executive functioning and (2) whether greater self-efficacy and cognitive reserve (CR) moderated this relationship.

Method:

Spousal dementia caregivers (n = 253) completed the Neuropsychiatric Inventory Questionnaire (stress exposure), the Perceived Stress Scale, the National Adult Reading Test (CR), the Fortinsky dementia-specific caregiver self-efficacy scale, and the Color Trails Test (executive functioning). Moderated mediation was tested using the PROCESS macro. Age, gender, and dementia risk factors were included as covariates.

Results:

Greater stress exposure indirectly predicted executive functioning through psychological stress. Stronger relationships between greater psychological stress and poorer executive functioning were observed among caregivers with lower CR; there was no evidence that self-efficacy moderated the relationship between stress exposure and psychological stress.

Conclusions:

Our findings are in line with the idea that greater psychological stress in response to challenges associated with dementia care predicts poorer caregiver executive functioning, particularly among caregivers with low CR. However, these findings are cross sectional; it is also possible that poorer executive functioning contributes to greater caregiver stress.

Keywords

carerscognitive impairmentrisk factorsdementia
Type
Research Article
Information
International Psychogeriatrics , Volume 29 , Issue 4 , April 2017 , pp. 615 - 625
Copyright
Copyright © International Psychogeriatric Association 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Arnsten, A. F. T. (2009). Stress signalling pathways that impair prefrontal cortex structure and function. Nature Reviews Neuroscience, 10, 410–422.Google Scholar
Bandura, A. (1997). Self-efficacy: The exercise of control. New York: Freeman.Google Scholar
Barnes, D. E. and Yaffe, K. (2011). The projected effect of risk factor reduction on Alzheimer's disease prevalence. The Lancet Neurology, 10, 819–828.Google Scholar
Baron, R. M. and Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.Google Scholar
Cahn-Weiner, D. A., Malloy, P. F., Boyle, P. A., Marran, M. and Salloway, S. (2000). Prediction of functional status from neuropsychological tests in community-dwelling elderly individuals. The Clinical Neuropsychologist, 14, 187–195.CrossRefGoogle ScholarPubMed
Cohen, S., Kamarck, T. and Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, 385–396.Google Scholar
Corrêa, M. S. et al. (2015). Psychophysiological correlates of cognitive deficits in family caregivers of patients with Alzheimer disease. Neuroscience, 286, 371–382.Google Scholar
Craig, C. L., et al. (2003). International physical activity questionnaire: 12-country reliability and validity. Medicine and Science in Sports and Exercise, 35, 1381–1395.Google Scholar
D'Elia, L., Satz, P., Uchiyama, C. and White, T. (1996). Color Trails Test: Professional Manual. Odessa, FL: Psychological Assessment Resources.Google Scholar
de Vugt, M. E. et al. (2006). Cognitive functioning in spousal caregivers of dementia patients: findings from the prospective MAASBED study. Age and Ageing, 35, 160–166.Google Scholar
Fonareva, I. and Oken, B. S. (2014). Physiological and functional consequences of caregiving for relatives with dementia. International Psychogeriatrics, 26, 725–747.Google Scholar
Fortinsky, R. H., Kercher, K. and Burant, C. J. (2002). Measurement and correlates of family caregiver self-efficacy for managing dementia. Aging & Mental Health, 6, 153–160.Google Scholar
Harrison, S. L., Sajjad, A., Bramer, W. M., Ikram, M. A., Tiemeier, H. and Stephan, B. C. (2015). Exploring strategies to operationalize cognitive reserve: a systematic review of reviews. Journal of Clinical and Experimental Neuropsychology, 37, 253–264.Google Scholar
Hayes, A. F. (2013). Introduction to Mediation, Moderation and Conditional Process Analysis: A Regression-Based Approach. New York: The Guilford Press.Google Scholar
Kaufer, D. I. et al. (2000). Validation of the NPI-Q, a brief clinical form of the neuropsychiatric inventory. The Journal of Neuropsychiatry and Clinical Neurosciences, 12, 233–239.Google Scholar
Lezak, M., Howieson, D. and Loring, D. (2004). Neuropsychological Assessment. New York: Oxford University Press.Google Scholar
Mackenzie, C. S., Wiprzycka, U. J., Hasher, L. and Goldstein, D. (2009). Associations between psychological distress, learning, and memory in spouse caregivers of older adults. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 64B, 742–746.Google Scholar
Manly, J. J., Schupf, N., Tang, M. X. and Stern, Y. (2005). Cognitive decline and literacy among ethnically diverse elders. Journal of Geriatric Psychiatry and Neurology, 18, 213–217.Google Scholar
Nelson, H. E. and Willison, J. (1991). National Adult Reading Test Manual. Windsor: NFER-Nelson.Google Scholar
Norton, M. C. et al. (2010). Greater risk of dementia when spouse has dementia? The cache county study. Journal of the American Geriatrics Society, 58, 895–900.Google Scholar
Oken, B. S., Fonareva, I. and Wahbeh, H. (2011). Stress-related cognitive dysfunction in dementia caregivers. Journal of Geriatric Psychiatry and Neurology, 24, 191–198.Google Scholar
Ornstein, K. and Gaugler, J. E. (2012). The problem with “problem behaviors”: a systematic review of the association between individual patient behavioral and psychological symptoms and caregiver depression and burden within the dementia patient–caregiver dyad. International Psychogeriatrics, 24, 1536–1552.Google Scholar
Pertl, M. M., Lawlor, B. A., Robertson, I. H., Walsh, C. and Brennan, S. (2015). Risk of cognitive and functional impairment in spouses of people with dementia: evidence from the health and retirement study. Journal of Geriatric Psychiatry and Neurology, 28, 260–271.Google Scholar
Pinquart, M. and Sorensen, S. (2003). Differences between caregivers and noncaregivers in psychological health and physical health: a meta-analysis. Psychology and Aging, 18, 250–267.Google Scholar
Rabinowitz, Y. G., Mausbach, B. T. and Gallagher-Thompson, D. (2009). Self-efficacy as a moderator of the relationship between care recipient memory and behavioral problems and caregiver depression in female dementia caregivers. Alzheimer Disease & Associated Disorders, 23, 389–394.Google Scholar
Radloff, L. S. (1977). The CES-D scale: a self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.Google Scholar
Siedlecki, K. L., Stern, Y., Reuben, A., Sacco, R. L., Elkind, M. S. and Wright, C. B. (2009). Construct validity of cognitive reserve in a multiethnic cohort: the northern Manhattan study. Journal of the International Neuropsychological Society, 15, 558–569.Google Scholar
Stern, Y. (2009). Cognitive reserve. Neuropsychologia, 47, 2015–2028.Google Scholar
Vitaliano, P. P., Echeverria, D., Shelkey, M., Zhang, J. and Scanlan, J. (2007). A cognitive psychophysiological model to predict functional decline in chronically stressed older adults. Journal of Clinical Psychology in Medical Settings, 14, 177–190.Google Scholar
Vitaliano, P. P., Murphy, M., Young, H. M., Echeverria, D. and Borson, S. (2011). Does caring for a spouse with dementia promote cognitive decline? A hypothesis and proposed mechanisms. Journal of the American Geriatrics Society, 59, 900–908.Google Scholar
Vitaliano, P. P., Zhang, J., Young, H. M., Caswell, L. W., Scanlan, J. M. and Echeverria, D. (2009). Depressed mood mediates decline in cognitive processing speed in caregivers. The Gerontologist, 49, 12–22.Google Scholar
Zhang, S., Guo, Q., Edwards, H., Yates, P. and Li, C. (2014). Self-efficacy moderation and mediation roles on BPSD and social support influences on subjective caregiver burden in Chinese spouse caregivers of dementia patients. International Psychogeriatrics, 26, 1465–1473.Google Scholar