Identity, relationship quality, and subjective burden in caregivers of persons with dementia.

The aim of the current study was to examine the associations between informal caregivers' perception of identity change in their care-partner, the quality of the caregiver/care-recipient relationship, and caregiver burden in a sample of 56 informal caregivers of persons with dementia. Most (96.4%) of the caregivers of persons who received a dementia diagnosis reported a perceived change in the identity of their care-partner. Caregivers' perception of relationship satisfaction was measured with the Burns Relationship Satisfaction Scale for premorbid relationship and current relationship quality, and caregiver burden was measured with the Zarit Burden scale. After controlling for variance due to dementia severity, premorbid relationship satisfaction, and current relationship satisfaction, caregivers' perceived change in the identity of the person with dementia accounted for significant variance in caregiver burden. Using a mediational model, we found support for a direct effect between perceived change in identity and caregiver burden, but we also found support for an indirect effect of relationship quality on the relation between perceived identity change and caregiver burden. The demonstrated model provides an empirically supported theoretical framework for guiding potential research and development of future interventions, which we suggest should emphasize dyads.

Reliable change and minimum clinically important difference (MCID) of the Repeatable Battery for the Assessment of Neuropsychology Status (RBANS) in a heterogeneous dementia sample: Support for reliable change methods but not the MCID.

We compare reliable change scores and recently published anchor-based cutoffs for minimum clinically important difference (MCID) for the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) in a sample of patients diagnosed with various forms of dementia. For memory clinic patients with dementia evaluated twice over a one-year interval (N = 53), observed retest RBANS index scores were compared with predicted retest index scores based on regression formulae developed from cognitively healthy older adults. Patient RBANS change scores were also compared to suggested MCID anchors. Patients with dementia demonstrated a reliable decline on most RBANS indices, with evidence that the Visuospatial/Constructional and Language Indices might be less sensitive to decline over time. Although there was consistency between MCID and reliable changes in this sample, there was a substantial proportion where the MCID was exceeded, with no reliable change. We attempted to create MCIDs from the Clinical Dementia Rating Sum of Box scores for RBANS reliable change scores, but failed to find significant associations. Overall, the findings support use of the regression based reliable change approach, but we caution use of the MCID approach for the RBANS.

Variance in caregiver burden predicted by patient behaviors versus neuropsychological profile.

Informal caregivers provide the majority of care to persons with dementia; efforts to support caregivers' well-being are increasingly important in the context of limited formal healthcare supports. Informal caregiving is commonly associated with caregiver burden and burden may depend upon patient characteristics including neuropsychological profile, dementia severity, and dementia etiology. This study investigated predictors of caregiver burden in a sample of 213 Memory Clinic patients diagnosed with dementia and whose caregivers provided collateral information. Caregiver burden was similar irrespective of dementia etiology. Beyond the expected predictive value of dementia severity on caregiver burden, patient behavioral symptoms, functional dependence, and caregiver psychological distress were predictive of caregiver burden. In contrast, care-recipient neuropsychological performance did not predict burden. These findings suggest that beyond severity of dementia, specific behavioral disturbances predict caregiver burden which may have implications for programming and intervention aimed at supporting and sustaining caregivers in their role.

Predictors of Completion of Executive-Functioning Tasks in a Memory Clinic Dementia Sample.

It has been observed that persons subsequently diagnosed with dementia often have difficulty completing commonly administered tests of executive function (EF). Interpretation of incompletion is problematic given the composite nature of EF tasks and the multiple impairments often demonstrated by persons with dementia. The goal of the present study was to determine the rate of failure to complete the Color-Word Stroop and Part B of the Trail-Making Test (TMT-B) in a clinical sample of persons with dementia and to explore neuropsychological predictors of incompletion. This study analyzed neuropsychological test data from 213 persons diagnosed with dementia at an interdisciplinary memory clinic. Index scores from the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) were examined as potential predictors of Color-Word Stroop and TMT-B completion in hierarchical logistic regression models. Rates of incompletion were high for both tests (60.6% for the Color-Word Stroop and 67.6% for the TMT-B). RBANS Language Index scores on the Color-Word Stroop predicted completion, while scores on the RBANS Visuospatial, Attention, and Immediate Memory indexes predicted TMT-B completion. The majority of the dementia sample was unable to complete the Color-Word Stroop and TMT-B executive tasks. Non-EF impairments may be implicated in completion of these tasks.

RBANS embedded measures of suboptimal effort in dementia: effort scale has a lower failure rate than the effort index.

The importance of evaluating effort in neuropsychological assessments has been widely acknowledged, but measuring effort in the context of dementia remains challenging due to the impact of dementia severity on effort measure scores. Two embedded measures have been developed for the repeatable battery for the assessment of neuropsychological status (RBANS; Randolph, C., Tierney, M. C., Mohr, E., & Chase, T. N. (1998). The repeatable battery for the assessment of neuropsychological status (RBANS): Preliminary clinical validity. Journal of Clinical and Experimental Neuropsychology, 20 (3), 310-319): the Effort Index (EI; Silverberg, N. D., Wertheimer, J. C., & Fichtenberg, N. L. (2007). An effort index for the repeatable battery for the assessment of neuropsychological status (RBANS). Clinical Neuropsychologist, 21 (5), 841-854) and the Effort Scale (ES; Novitski, J., Steele, S., Karantzoulis, S., & Randolph, C. (2012). The repeatable battery for the assessment of neuropsychological status effort scale. Archives of Clinical Neuropsychology, 27 (2), 190-195). We explored failure rates on these effort measures in a non-litigating mixed dementia sample (N = 145). Failure rate on the EI was high (48%) and associated with dementia severity. In contrast, failure on the ES was 14% but differed based on type of dementia. ES failure was low (4%) when dementia was due to Alzheimer disease (AD), but high (31%) for non-AD dementias. These data raise concerns about use of the RBANS embedded effort measures in dementia evaluations.

Psychological essentialism and nationalism as determinants of interethnic bias.

The present study examined whether individuals without strong national identity (i.e., low nationalism) would be susceptible to temporarily elicited essentialism to alter their mental representations of ethnic boundaries, and thus increase interethnic bias. To test these ideas we experimentally induced essentialist beliefs among Japanese subjects about the boundary between Japanese and Chinese ethnicities, while measuring the strength of nationalism as an individual variable. The results were generally consistent with predictions, suggesting that the activation of essentialist beliefs can strengthen interethnic biases among people without strong nationalism.