Burden and Depression among Empirically-Derived Subgroups of Family Caregivers for Individuals With Dementia.

Dementia caregiving experiences are not universal and different factors may influence the risk for burden and depression. This study examined factors such as the relationship with the care recipient, severity of dementia, and relationship satisfaction to uncover different types of caregiver burden profiles using baseline assessment for a telephone-based intervention study for dementia caregivers. Participants (n = 233) completed a battery of psychological and caregiving related surveys. The sample was predominantly White and female. Latent class analysis suggested four class models in subsamples of spousal caregivers and adult children caregivers. The results suggested four distinct classes among samples of spousal and adult child caregivers. Differences in burden emerged across both spouses and adult children, and differences in depression also emerged in the spousal sample. Our findings demonstrate the diversity of the caregiving experience and suggest that future psychosocial interventions may benefit from being tailored to the needs of caregiver subgroups.

Sex-specific differences in neuropsychological profiles of mild cognitive impairment in a hospital-based clinical sample.

OBJECTIVE: Mild cognitive impairment (MCI) is an etiologically nonspecific diagnosis including a broad spectrum of cognitive decline between normal aging and dementia. Several large-scale cohort studies have found sex effects on neuropsychological test performance in MCI. The primary aim of the current project was to examine sex differences in neuropsychological profiles in a clinically diagnosed MCI sample using clinical and research diagnostic criteria. METHOD: The current study includes archival data from 349 patients (age M = 74.7; SD = 7.7) who underwent an outpatient neuropsychological evaluation and were diagnosed with MCI. Raw scores were converted to z-scores using normative datasets. Sex differences in neurocognitive profiles including severity, domain-specific composites (memory, executive functioning/information processing speed, and language), and modality-specific learning curves (verbal, visual) were examined using Analysis of Variance, Chi-square analyses, and linear mixed models. Post hoc analyses examined whether sex effects were uniform across age and education brackets. RESULTS: Females exhibit worse non-memory domain and test-specific cognitive performances compared to males with otherwise comparable categorical MCI criteria and global cognition measured via screening and composite scores. Analysis of learning curves showed additional sex-specific advantages (visual Males>Females; verbal Females >Males) not captured by MCI subtypes. CONCLUSIONS: Our results highlight sex differences in a clinical sample with MCI. The emphasis of verbal memory in the diagnosis of MCI may result in diagnosis at more advanced stages for females. Additional investigation is needed to determine whether these profiles confer greater risk for progressing to dementia or are confounded by other factors (e.g., delayed referral, medical comorbidities).

A Pilot Study of the Fluctuating Mental Status Evaluation: A Novel Delirium Screening Tool for Neurocritical Care Patients.

BACKGROUND: Delirium occurs frequently in patients with stroke and neurocritical illness but is often underrecognized. We developed a novel delirium screening tool designed specifically for neurocritical care patients called the fluctuating mental status evaluation (FMSE) and aimed to test its usability and accuracy in a representative cohort of patients with intracerebral hemorrhage (ICH). METHODS: We performed a single-center prospective study in a pilot cohort of patients with ICH who had daily delirium assessments throughout their admission. Reference-standard expert ratings were performed each afternoon using criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and were derived from bedside assessments and clinical data from the preceding 24 h. Paired FMSE assessments were performed by patients' clinical nurses after receiving brief one-on-one training from research staff. Nursing assessments were aggregated over 24-h periods (including day and night shifts), and accuracy of the FMSE was analyzed in patients who were not comatose to determine optimal scoring thresholds. RESULTS: We enrolled 40 patients with ICH (mean age 71.1 ± 12.2, 55% male, median National Institutes of Health Stroke Scale score 16.5 [interquartile range 12-20]), of whom 85% (n = 34) experienced delirium during their hospitalization. Of 308 total coma-free days with paired assessments, 208 (68%) were rated by experts as days with delirium. Compared with expert ratings, FMSE scores ≥ 1 had 86% sensitivity and 73% specificity on a per-day basis, whereas FMSE scores ≥ 2 had 68% sensitivity and 82% specificity. Accuracy remained high in patients with aphasia (FMSE scores ≥ 1: 83% sensitivity, 77% specificity; FMSE scores ≥ 2: 68% sensitivity, 85% specificity) and decreased arousal (FMSE scores ≥ 1: 80% sensitivity, 100% specificity; FMSE scores ≥ 2: 73% sensitivity, 100% specificity). CONCLUSIONS: In this pilot study, the FMSE achieved a high sensitivity and specificity in detecting delirium. Follow-up validation studies in a larger more diverse cohort of neurocritical care patients will use score cutoffs of ≥ 1 as "possible" delirium and ≥ 2 as "probable" delirium.

Healthy Lifestyle Behaviors and Viewpoints Among Members of an Alzheimer Prevention Registry.

BACKGROUND: Research on Alzheimer disease and related dementias is increasingly focused on preventative strategies to target modifiable risk factors (eg, exercise, diet, cognitive stimulation) to reduce risk of cognitive decline, though it remains difficult for adults to adopt and maintain these behaviors on their own. METHODS/PARTICIPANTS: In this survey study, we examined knowledge about modifiable risk factors for dementia, engagement in healthy lifestyle behaviors, and associated barriers/facilitators in an Alzheimer disease prevention registry of at-risk, cognitively normal adults (n=135: 77% female; 96% Caucasian and non-Hispanic; mean age=66.1; 79% with family history of dementia; 46% with subjective memory decline). RESULTS: Participants reported high levels of engagement in exercise (mean 3.4 d/wk), a healthy diet (60% with a healthy/balanced diet), and cognitive stimulation (52% engaging in cognitive stimulation 3 to 7 d/wk), and most (56% to 57%) reported moderate to high knowledge about dementia and modifiable risk factors. Family history of dementia was associated with greater knowledge of risk factors for dementia (P=0.017), but not with knowledge of lifestyle recommendations to reduce risk (P=0.85). Most participants (63%) reported a preference for walking/running over other types of aerobic exercise. On average, participants reported that they would be willing to increase healthy lifestyle behaviors to achieve "moderate" risk reduction for dementia (∼21% to 23%, on a scale from 0% to 40%, reflecting mildly to substantially reduced risk). CONCLUSION: Results broaden our understanding of current habits and willingness to engage in healthy lifestyle behaviors, which may inform individualized lifestyle interventions and/or design of prevention trials, particularly among at-risk adults with subjective or mild cognitive concerns, who may be especially motivated and able to engage in lifestyle interventions, to optimize brain health and reduce risk of cognitive decline.

Dysexecutive Behaviors Mediate the Relationship Between Functional Impairment and Caregiver Burden in Mild Cognitive Impairment.

Mild cognitive impairment (MCI) is often accompanied by executive dysfunction (ED), dysexecutive behaviors (DB), and functional impairment (FI). The respective contributions of ED, DB, and FI to caregiver burden in MCI are not well understood. The present study hypothesized that while all factors would predict caregiver burden in MCI, ED and family-reported DB would account for greater variance in caregiver burden and mediate the relationship between FI and caregiver burden. In our sample (n = 94), linear regression revealed that FI and DB predicted caregiver burden, but that DB predicted caregiver burden above and beyond the contribution of FI. DB mediated the relationship between FI and caregiver burden. These results add to a body of work demonstrating that presence of DB and FI are distressing to family members, even in mild disease stages. Because DB may account for the relationship between FI and caregiver burden, early identification of family members reporting DB in the person with MCI is imperative so that supports can be made available.

Development of an assessment measure for sexual disinhibition in dementia.

OBJECTIVE: Sexual disinhibition (SD), a neuropsychiatric symptom characterized by sexually inappropriate comments and/or behaviors, remains under identified in dementia, possibly due to a lack of standardized assessment methods. A recent systematic review of measures used to assess SD proposed four behavioral domains and identified the need for a population-specific measure. The present study addressed this by examining the underlying factor structure of SD to create a new caregiver-report measure. METHODS: Dementia caregivers (n = 622) recruited online were randomly assigned to Initial Validation (n = 311) or Cross-Validation (n = 311) groups. RESULTS: Initial Validation revealed five behavioral domains that served as provisional scales for cross-validation, leading to measure development. CONCLUSIONS: The current study is the first to statistically evaluate the underlying factor structure of SD, resulting in a new measure that can help better characterize and identify SD.

Verbal memory is associated with adherence to COVID-19 protective behaviors in community dwelling older adults.

BACKGROUND: Adherence to protective behaviors is central to limiting the spread of COVID-19 and associated risk of serious illness and mortality in older populations. Whether cognition predicts adherence to protective behaviors has not been examined in older adults. AIMS: To examine whether specific cognitive abilities predict adherence to COVID-19 protective behaviors in older adults, independent of other relevant factors. METHODS: Data from 431 older adults (i.e., ≥ 65 years) who took part in the COVID-19 module of the Health and Retirement Study were included in the present study. Separate binary logistic regression models were used to examine whether performance on measures of immediate and delayed recall and working memory predicted adherence to COVID-19 protective behaviors, controlling for demographics, level of COVID-19 concern, depressive symptoms, and medical conditions. RESULTS: For every unit increase in immediate and delayed recall, the probability of adhering to COVID-19 protective behaviors increased by 47% and 69%, respectively. There was no association between the measure of working memory and adherence. DISCUSSION: It is of public interest to understand the factors that reduce adherence to protective behaviors so that we can better protect those most vulnerable and limit community spread. Our findings demonstrate that reduced memory predicts non-adherence to COVID-19 protective behaviors, independent of virus concern, and other relevant demographic and health factors. CONCLUSIONS: Public health strategies aimed at increasing adherence to COVID-19 protective behaviors in community dwelling older adults, should account for the role of reduced cognitive function in limiting adherence.

Differences in Burden Severity in Adult-Child Family Caregivers and Spousal Caregivers of Persons with Dementia.

Researchers are continuing to focus on the nature and sources of burden of family caregivers of persons living with dementia. Caregiving stress and burden are assessed and addressed by social workers, including at high-risk times such as hospitalization. This study tested whether adult-child family caregivers experience greater perceived burden than spousal caregivers, accounting for risks of acute stress which can accompany hospitalization for their care recipient, where social workers may be meeting with family caregivers for the first time. Family caregivers (N = 76; n = 42 adult-child; n = 34 spouse) were recruited during care-recipient clinical treatment. The settings of care included an outpatient memory care program and an inpatient geriatric psychiatry service. Results showed that adult-child caregivers reported greater burden as compared with spousal caregivers, but no differences regarding depressive symptoms, perceived stress, or grief. After controlling for demographics and location of care, being an adult-child caregiver remained a predictor of greater burden severity. Being an adult-child family caregiver may place an individual at increased risk for experiencing high burden. These findings suggest socials workers should consider how adult-child caregivers may benefit from strategies to address and reduce burden, beyond those typically offered to spousal caregivers.

The Role of Sexual Disinhibition to Predict Caregiver Burden and Desire to Institutionalize Among Family Dementia Caregivers.

Neuropsychiatric symptoms in dementia are associated with greater caregiver burden and desire to institutionalize, though previous work largely examines the cumulative effects of many behavioral symptoms. Sexual disinhibition could be particularly stressful due to stigma attached to these behaviors. Links between care recipient sexual disinhibition, caregiver burden, and caregiver desire to institutionalize were examined by analyzing cross-sectional data from 730 family caregivers recruited online. Caregiver burden, caregiver desire to institutionalize, and neuropsychiatric symptoms, including sexual disinhibition, were assessed via caregiver report. Burden (P < .001) and desire to institutionalize (P = .008) were greater among caregivers who endorsed sexual disinhibition. Sexual disinhibition uniquely predicted desire to institutionalize after accounting for presence (P = .02) and severity (P = .03) of other neuropsychiatric symptoms. A similar pattern was seen for burden (presence P < .04; severity P = .06), and follow-up analyses revealed caregiver burden mediated the relationship between care recipient sexual disinhibition and caregiver desire to institutionalize (presence bias-corrected 95% confidence intervals [BCa 95% CI] [0.003, 0.08], severity BCa 95% CI [0.007, 0.06]). Sexual disinhibition appears to be a particularly difficult neuropsychiatric symptom for the family caregiver, contributing to desire to institutionalize via caregiver burden.

Olfactory and Neuropsychological Functioning in Olfactory Reference Syndrome.

BACKGROUND: Olfactory reference syndrome (ORS) is an underrecognized, understudied, and often severe psychiatric disorder characterized by a prominent and distressing or impairing preoccupation with a false belief of emitting an offensive body odor. As this condition has only recently been recognized in the International Classification of Diseases (the 11th Edition), no empirical evidence exists about the underlying features and etiology of the disorder. OBJECTIVE: To examine the neuropsychological and olfactory functioning of individuals with ORS and address whether there is central nervous system or sensory dysfunction associated with the condition. METHODS: In this preliminary investigation, 9 consecutive participants with ORS completed a structured clinical interview and neuropsychological and olfaction evaluations. RESULTS: A proportion of individuals with ORS displayed deficits in aspects of cognitive functioning (i.e., processing speed, executive functioning, recognition memory bias for ORS-related words), olfaction functioning (i.e., odor detection and discrimination), and emotional processing. CONCLUSIONS: Based on these preliminary findings of cognitive, olfaction, and emotional processing deficits in individuals with ORS, further neuropsychological and olfaction studies are needed that better characterize this understudied patient group and address this study's limitations.

Identification of Sexual Disinhibition in Dementia by Family Caregivers.

PURPOSE: Sexual disinhibition in dementia is understudied and discrepant frequency rates are reported. Measures designed to capture general disinhibition may under-identify sexual disinhibition, and lack of assessment uniformity may contribute to inconsistent endorsement. The current study aimed to determine: (1) whether an item from a commonly used measure tapping into general disinhibition would detect sexual disinhibition, (2) whether differently worded items specifically addressing sexual disinhibition would elicit inconsistent endorsement, and (3) whether different caregiver types would yield discrepant endorsement. METHODS: Data for this cross-sectional, observational study were collected online using items from the Neuropsychiatric Inventory, Cohen-Mansfield Agitation Inventory, and novel items developed to assess sexual disinhibition. PATIENTS: In total, 779 family dementia caregivers were recruited from social media caregiver groups. RESULTS: In total, 26.2% of caregivers who explicitly endorsed sexual disinhibition did not endorse general disinhibition. Frequency of endorsement for sexual disinhibition differed depending upon item wording and nature of the caregiver relationship, including higher endorsement by spouses overall. DISCUSSION: Inquiring generally about disinhibition may under-identify presence of sexual disinhibition. Lack of standardization may contribute to inconsistent frequency rates and characterization of this problem. More work is needed to better understand and identify sexual disinhibition in dementia.

Comparing the Mini-Mental State Examination and the modified Mini-Mental State Examination in the detection of mild cognitive impairment in older adults.

ABSTRACTObjectives:To show enhanced psychometric properties and clinical utility of the modified Mini-Mental State Examination (3MS) compared to the Mini-Mental State Examination (MMSE) in mild cognitive impairment (MCI). DESIGN: Psychometric and clinical comparison of the 3MS and MMSE. SETTING: Neuropsychological clinic in the northeastern USA. PARTICIPANTS: Older adults referred for cognitive concerns, 87 of whom were cognitively intact (CI) and 206 of whom were diagnosed with MCI. MEASUREMENTS: The MMSE, the 3MS, and comprehensive neuropsychological evaluations. RESULTS: Both instruments were significant predictors of diagnostic outcome (CI or MCI), with comparable odds ratios, but the 3MS explained more variance and showed improved classification accuracies relative to the MMSE. The 3MS also demonstrated greater receiver operating characteristic area under the curve values (0.85, SE = 0.02) compared to the MMSE (0.74, SE = 0.03). Scoring lower than 95/100 on the 3MS suggested MCI, while scoring lower than 28/30 on the MMSE suggested MCI. Additionally, compared to the MMSE, the 3MS shared more variance with neuropsychological composite scores in Language and Memory domains but not in Attention, Visuospatial, and Executive domains. Finally, 65.5% MCI patients were classified as impaired (scoring ≤1 SD below the mean) using 3MS normative data, compared to only 11.7% of patients who were classified as impaired using MMSE normative data. CONCLUSIONS: Broadly speaking, our data strongly favor the widespread substitution of the MMSE with the 3MS in older adults with concerns for cognitive decline.

Guilt after placement questionnaire: a new instrument to assess caregiver emotional functioning following nursing home placement.

OBJECTIVE: Guilt is a core feature of dementia caregivers' experiences following placement. This study describes and validates a new assessment tool for monitoring caregiver adjustment after placement. METHODS: Forty-six items addressing ambivalence and guilt about placement were tested with 170 dementia caregivers (M age = 56.79, SD = 13.19; 69.4% female; 54.7% adult child). RESULTS: Using principal axis factor analysis, 10 items were retained that showed acceptable internal consistency (Cronbach's alpha of 0.92). Construct validity was established in a subset of the sample (n = 53) with measures of depression (r = 0.53), burden (r = 0.48), conflict with staff (r = 0.47), and well-being (r = -0.30). CONCLUSIONS: This scale may be used to identify caregivers at risk for adjustment problems following placement and to monitor adjustment over time.

The Modified Telephone-Administered Minnesota Cognitive Acuity Screen for Mild Cognitive Impairment.

OBJECTIVE: This study aimed to compare the sensitivity and specificity of a modified version of the Minnesota Cognitive Acuity Screen (MCAS-m), by adding learning and recognition memory components, to the original version MCAS to distinguish amnestic mild cognitive impairment (aMCI) from healthy controls (HCs). METHODS/DESIGN: A total of 30 individuals with aMCI and 30 HCs underwent neuropsychological testing, neurologic examination, laboratory, and brain imaging tests. Once diagnosis was confirmed, participants completed the MCAS and MCAS-m in counterbalanced order. RESULTS: The average administration time was 12.6 minutes for the MCAS and 13.5 minutes for the MCAS-m. Receiver operating characteristic curve analyses showed that the MCAS-m demonstrated 97% sensitivity and 97% specificity for distinguishing between aMCI and HC versus 97% and 87%, respectively, for the original MCAS in this sample. CONCLUSIONS: Both the MCAS and the MCAS-m were highly sensitive when distinguishing between normal cognition and aMCI; however, the MCAS-m demonstrated a 10% increase in specificity compared to the original version. Improved specificity is particularly relevant to screening in larger community samples with lower base rates of MCI than clinic populations. This modified screening measure presents a brief and cost-effective tool for identifying MCI. Given the risk of progression from aMCI to Alzheimer disease dementia (AD), the MCAS-m represents a modest improvement in telephone-administered methods for the early detection of AD.

Telephone-based Minnesota Cognitive Acuity Screen predicts time to institutionalization and homecare.

ABSTRACTBackground:We assessed the ability of a telephone-administered cognitive screening test - Minnesota Cognitive Acuity Screen (MCAS) - to predict time to assisted living/nursing home placement (i.e. institutionalization) and homecare/institutionalization in healthy controls (HC), mild cognitive impairment (MCI), and Alzheimer's disease (AD). METHODS: Participants (N = 146; HC = 37; MCI = 70; AD = 39) had baseline MCAS testing and were re-contacted over eight years for dates of starting homecare, institutionalization, and death. Occasionally, outcomes were obtained via medical records. Accounting for informative censoring due to death within a competing risks framework, Cox regression examined the associations of baseline MCAS performance with the start of (a) institutionalization and (b) homecare/institutionalization. RESULTS: Hazard ratios (HR) captured the effect of a ten-point difference in baseline MCAS scores, corresponding to a change from the MCI/HC to AD/MCI boundaries. In unadjusted models, increased baseline cognitive impairment was associated with nearly two-fold increases in the hazard of institutionalization (HR = 1.81, 95% CI = 1.32, 2.48) and homecare/institutionalization (HR = 1.87, 95% CI = 1.44, 2.42). However, hazards were not proportional over time in models adjusting for sex. This was resolved when regressions were run for men and women separately. Both sexes showed significant increases in the hazard of institutionalization (Females: HR = 2.39, 95% CI = 1.53-3.74; Males: HR = 1.68, 95% CI = 1.02-2.76) and homecare/institutionalization (Females: HR = 2.31, 95% CI = 1.66, 3.21; Males: HR = 1.98, 95% CI = 1.32, 2.96) with increased impairment, although hazards were lower for males. CONCLUSIONS: Telephone-administered MCAS provides useful information about the risk of needing homecare assistance or institutionalization. It may be particularly useful when office/home visits are prohibitive but cognitive monitoring is indicated.

Gender effects on components of burden and depression among dementia caregivers.

OBJECTIVE: Previous literature has examined burden and depression predominately as unitary constructs in relation to dementia caregiving. No studies thus far have examined gender differences in the specific components of burden and depression in dementia caregivers. The current study examined whether empirically validated dimensions of caregiver burden differed by gender for dementia caregivers. METHODS: The sample consisted of 211 dementia caregivers enrolled in a longitudinal intervention study. Only baseline functioning was evaluated in this study. Levels of burden were assessed using the Zarit Burden Interview (ZBI), and levels of depression were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). RESULTS: Factor analysis revealed three facets of burden: impact of caregiving on the caregivers' lives, guilt, and frustration/embarrassment, and four facets of depression: depressed affect, somatic activity, positive affect, and interpersonal feelings. Overall burden (p < .001) and impact of caregiving on the caregivers' life (p < .001) were significantly higher in females. Overall levels of depression (p = .018), somatic and retarded activity (p = .018), depressed affect (p = .005), and positive affect (p = .012) were significantly higher in females. CONCLUSIONS: Findings suggest that distressed male and female dementia caregivers experience caregiving differently. Results from this study could be used to identify gender-specific interventions related to subtypes of burden and depression to optimize quality of life for caregivers.

Depressive Symptoms Contribute to Executive Deficits in Temporal Lobe Epilepsy.

This study examined the contribution of depression to reduced executive functioning in temporal lobe epilepsy (TLE) using three groups: TLE only (TLE; N=29), TLE+depression (TLE+DEP) (N=22), and nonneurologic participants with depression (DEP; N=31). Participants completed the Delis-Kaplan Executive Function System. Individuals with TLE performed worse than the DEP group on many tests of executive functions. Among the TLE participants, those with depression demonstrated poorer executive functioning. These findings support the notion that depression may further contribute to executive difficulties in individuals with TLE. Depression treatment in this population could lead to improvements in cognition.

Cognitive impairment in older adults with epilepsy: Characterization and risk factor analysis.

OBJECTIVE: Cognitive deficits are common in epilepsy, though the impact of epilepsy on cognition in older adults is understudied. This study aimed to characterize cognition in older adults with epilepsy compared with healthy older adults and identify potential risk factors for impairment. METHODS: Thirty-eight older adults with epilepsy and 29 healthy controls completed a comprehensive neuropsychological battery, as well as measures of depression and anxiety. Chart review for current medications, seizure history, and neuroimaging was also completed. To compare cognitive performance between groups, ANOVA was used, and linear regression identified predictors of impairment among the group with epilepsy. RESULTS: Patients with epilepsy performed worse across nearly all cognitive domains, and were clinically impaired (i.e., ≥ 1.5 SD below mean) on more individual tests when compared with controls, including a subset of patients with epilepsy with normal MRIs. For all patients with epilepsy, taking a greater number of antiepileptic drugs was associated with poorer language and visuospatial abilities, and higher anxiety was associated with poorer visual memory. CONCLUSIONS: Older adults with epilepsy demonstrated greater cognitive deficits than matched controls. Polytherapy and anxiety heightened the risk for cognitive impairment in some cognitive domains, but not in others. Understanding the nature of cognitive decline in this population, as well as associated risk factors, may assist in the differential diagnosis of cognitive complaints and improve the design of treatment studies for older patients with epilepsy. Replication in larger, longitudinal studies is warranted to generalize these findings.

Subjective cognitive complaints versus objective neuropsychological performance in older adults with epilepsy.

Memory complaints are common among older adults with epilepsy (OAE), though discrepancy between subjective complaints and objective performance often exists. This study examined how accurately OAE and their informants reported on the participant's cognitive difficulties by comparing ratings of everyday cognition to objective performance. Thirty-seven OAE and 27 older adult controls completed a brief battery of neuropsychological tests, the Beck Depression Inventory, and the Cognitive Difficulties Scale (CDS). Each participant had an informant who completed the CDS. Older adults with epilepsy performed worse than controls on cognitive testing and reported more subjective cognitive complaints. Neither participant- nor informant-reported cognitive complaints were related to performance on any of the neuropsychological tests for either the group with epilepsy or control group, but both were related to greater depressive symptoms. Results suggest that subjective report of cognitive problems by both OAE and their informants may not reliably reflect the extent to which these problems exist.

Psychosocial telephone intervention for dementia caregivers: A randomized, controlled trial.

BACKGROUND: Identifying effective and accessible interventions for dementia caregivers is critical as dementia prevalence increases. OBJECTIVE: Examine the effects of a telephone-based intervention on caregiver well-being. DESIGN: Randomized, controlled trial. SETTING: Academic medical center. PARTICIPANTS: Two hundred and fifty distressed, family, dementia caregivers. INTERVENTION: Caregivers randomized to receive 16 telephone contacts over 6 months of either the Family Intervention: Telephone Tracking-Caregiver (FITT-C) or Telephone Support (TS). OUTCOME: Primary outcome variables were family caregivers' depressive symptoms, burden, and reactions to care recipients' behavior problems at 6 months. RESULTS: The FITT-C intervention resulted in significantly improved caregiver depressive symptoms (P = .003; 27% net improvement) and less severe reactions to care-recipient depressive behaviors (P = .009; 29% net improvement) compared with the control condition (TS). CONCLUSION: An entirely telephone-based intervention improves caregivers' depressive symptoms and reactions to behavior problems in the care recipient and is comparable with reported results of face-to-face interventions.