Chen, Enna

Abstract Caregivers for people with neurodegenerative disease (PWNDs) often experience mental and physical health problems, especially when caring for PWNDs who have deficits in emotional functioning. We studied 65 PWNDs and their caregivers both during active caregiving and after caregiving had ended to determine: (a) how caregiver health changes after caregiving ends; and (b) whether PWNDs’ emotional functioning predicts these changes. PWND emotional functioning was assessed in the laboratory by measuring their generation of preparatory physiological activity (e.g., increased heart rate) to an upcoming emotional event (i.e., emotion eliciting films). Caregiver mental and physical health were measured using the Short-Form Health Survey (SF36) during active caregiving and again after caregiving had ended. Results indicated that, overall, caregivers reported increases in mental health, (t(36) = 2.58, p = .014, 95% CI [1.31, 10.93]) but decreases in physical health (t(36) = -2.35, p = .025, 95% CI [-7.26, -0.53]) across the two measurement periods. Using latent change score models, PWNDs’ preparatory physiological response impairments were associated with better caregiver mental health trajectories (β = -0.37, SE = 0.04, p = .003) such that smaller PWND preparatory responses predicted greater improvements in caregiver mental health (β = 9.92, SE = 2.84, p < .001). There was no association with changes in caregiver physical health. Smaller preparatory physiological responses in PWNDs may indicate diminished emotional responding, which is linked with lower caregiver mental health during active caregiving. Once caregiving ends, these caregivers may be most likely to “rebound” and show improvements in mental health.

Abstract Objectives Emotional impairments in people with dementia can be taxing for family caregivers. However, caregivers differ in their resilience to these challenges. We previously found that, compared to healthy controls and people with Alzheimer’s disease, people with frontotemporal lobar degeneration (FTLD) have smaller physiological responses when anticipating upcoming emotional stimuli. This impairment may leave these people with FTLD unprepared for upcoming emotional stimuli because they cannot mount responses needed for appropriate behaviors, which may create stress and difficulties for caregivers. We examined (a) whether smaller preparatory physiological responses in people with dementia are associated with lower emotional well-being and physical functioning in caregivers; and (b) whether these associations are moderated by the dyads’ relationship quality. Methods A total of 158 individuals with FTLD or Alzheimer’s disease and their family caregivers participated. Preparatory physiological responses in people with dementia were quantified as decreases in cardiac interbeat intervals from baseline to an instruction period, during which they were told they would be watching an upcoming emotional film. Caregivers self-reported their emotional well-being, physical functioning, and relationship quality with the people with dementia. Results Smaller preparatory physiological responses in people with dementia were associated with lower emotional well-being (but not physical functioning) in caregivers. This association was moderated by relationship quality (i.e., weakened for caregivers in higher-quality relationships). Discussion Findings advance understanding of risk and resilience factors for negative caregiver outcomes. Positive interpersonal processes in high-quality relationships (e.g., positive appraisal of aberrant behaviors) may buffer caregivers from the impact of emotional impairments in people with dementia.