Greater Risk of Dementia When Spouse Has Dementia? The Cache County Study
[See editorial comments by Dr. Peter P. Vitaliano, pp 976–978]
Maria C. Norton, PhD,abc Ken R. Smith, PhD,de Truls Østbye, MD, PhD,fgh JoAnn T. Tschanz, PhD,bc Chris Corcoran, ScD,ci Sarah Schwartz, MS,ci Kathleen W. Piercy, PhD,ac Peter V. Rabins, MD, MPH,j David C. Steffens, MD,k Ingmar Skoog, MD, PhD,l John C. S. Breitner, MD, MPH,mn Kathleen A. Welsh-Bohmer, PhD,g for the Cache County Investigators
OBJECTIVES: To examine the effects of caring for a spouse with dementia on the caregiver’s risk for incident dementia. DESIGN: Population-based study of incident dementia in spouses of persons ...view middle of the document...
Portions of this paper were presented at the International Conference on Alzheimer’s Disease in Vienna, Austria, July 11–16, 2009. Address correspondence to Maria Norton, Cache County Memory Study, Utah State University, 4440 Old Main Hill, Logan, UT 84322. E-mail: maria. firstname.lastname@example.org DOI: 10.1111/j.1532-5415.2010.02806.x
(HRR 5 11.9, 95% CI 5 1.7–85.5, P 5.01) than wives (HRR 5 3.7, 95% CI 5 1.2–11.6, P 5.03). CONCLUSION: The chronic and often severe stress associated with dementia caregiving may exert substantial risk for the development of dementia in spouse caregivers. Additional (not mutually exclusive) explanations for ﬁndings are discussed. J Am Geriatr Soc 58:895–900, 2010.
Key words: dementia; caregiving; stress
nformal (unpaid) dementia caregiving for a spouse is a natural marital obligation. Spousal caregivers may report positive feelings toward caregiving,1 yet dementia caregiving is difﬁcult, requiring time, energy, and usually physical exertion in provision of personal and instrumental assistance to a spouse with dementia (the care recipient). Dementia caregiving can incur a sense of loss of personal control or individual being2 and is also associated with depression,3,4 physical health problems,5 and mortality.6 Dementia caregivers have been shown to provide more assistance, and to report more personal sacriﬁces and stress, than those who care for physically impaired older adults.7 Generally, spouses of persons who suffer from dementia experience considerable stress, observing the deterioration of their life partner. The effects of this stress, which have been most studied in the context of caregiving, may increase the risk of negative cognitive outcomes in the spouse, although this has been relatively unexplored. One possible mechanism is the detrimental effects of chronic stress on the hippocampus, a brain region responsible for memory.8–10 There may be a relationship between having a spouse with dementia and adverse cognitive function with stress as potential mediator. One study showed that lower
JAGS 58:895–900, 2010 r 2010, Copyright the Authors Journal compilation r 2010, The American Geriatrics Society
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scores on a digit–symbol test of complex attention and cognitive speed in caregivers of spouses with dementia (than for non-caregiving controls) were no longer signiﬁcant after controlling for subjective stress.11 This suggests that distress explains the link between exposure and adverse cognitive outcomes in spouses of persons with dementia. The Nurses Health Study showed that women caring for an ill or disabled spouse performed worse than women who were not providing care on a general cognitive screening test.12 One longitudinal study found that decline in vocabulary over a 2-year period was greater in caregivers of spouses with dementia than in controls.13 Higher hostile attribution and metabolic risk in caregivers...