@article {7361, title = {Brain Structural Markers and Caregiving Characteristics as Interacting Correlates of Caregiving Strain.}, journal = {Am J Geriatr Psychiatry}, year = {2017}, month = {2017 Feb 21}, abstract = {

OBJECTIVE: To evaluate the association between brain structural markers and caregiving strain among older informal caregivers.

DESIGN: A secondary data analysis combining data from the Caregiver Health Effects Study (1993-1994) and the Cardiovascular Health Study MRI examination (1992-1994).

SETTING: Four United States communities.

PARTICIPANTS: Co-residing spousal caregivers (N = 237; mean age: 76.2 years, SD: 2.2 years).

MEASUREMENTS: Visually rated ventricular and white matter (WM) grades from magnetic resonance imaging, caregiving strain defined as "emotional or physical strain associated with providing care" for any of 12 activities of daily living (ADLs) and instrumental activities of daily living (IADLs), plus measures of caregiving characteristics and caregiver{\textquoteright}s health.

RESULTS: Overall, 56\% of caregivers reported strain. We detected an interaction where strain was very common (>82\%) among caregivers who helped with four or more IADLs, regardless of WM grades, and among caregivers with the worst WM grades (WM grades >=4), regardless of the number of IADLs they helped with. Among caregivers helping with fewer than four IADLs, having WM grade 4 or greater was associated with a 55\% higher prevalence ratio for reporting strain. This association remained statistically significant but was most markedly attenuated by adjustments for: care recipient{\textquoteright}s memory and behavioral problems, caregiver{\textquoteright}s depression symptoms, and caregiver{\textquoteright}s ADL impairment.

CONCLUSIONS: Caregiving strain is very common among older informal caregivers who provide help with many IADLs, and among caregivers who help with fewer IADLs, but have manifest signs of white matter pathology. Modern quantitative-neuroimaging studies are needed to evaluate whether more subtle variability in brain structure confers caregiving strain and the related health consequences.

}, issn = {1545-7214}, doi = {10.1016/j.jagp.2017.02.015}, author = {Smagula, Stephen F and Beach, Scott and Rosso, Andrea L and Newman, Anne B and Schulz, Richard} } @article {9108, title = {Associations of modifiable behavioral risk factor combinations at 65-74 years old with cognitive healthspan over 20 years.}, journal = {Psychosom Med}, year = {2022}, month = {2022 Jun 28}, abstract = {

OBJECTIVE: Behavioral risk factors for dementia tend to co-occur and inter-relate, especially poor diet, physical inactivity, sleep disturbances, and depression. Having multiple of these modifiable behavioral risk factors (MBRFs) may predict a particularly shortened cognitive healthspan, and therefore, may signal high-risk status/high intervention need.

METHODS: This secondary analyses of data from the Cardiovascular Health Study included 3149 participants aged 65-74 years (mean age = 69.5, standard deviation (SD) = 2.5; 59.6\% female). MBRF exposures were self-reports regarding: (1) diet, (2) activity, (3) sleep, and (4) depression symptoms. We primarily analyzed MBRF counts. Over up to 26 years of follow-up, we assessed the: (1) number of remaining cognitively healthy life years (CHLYs); and (2) percentage of remaining life years (LYs) that were CHLYs (\%CHLY). We estimated CHLYs as time before a dementia diagnosis, cognitive screener scores indicating impairment, proxy port indicating significant cognitive decline, or dementia medication use.

RESULTS: Participants averaged a remaining 16 LYs (SD = 7), 12.2 CHLYs (SD = 6.6), and 78.1\% of LYs being CHLYs (SD = 25.6). Compared with having no MBRFs, having one was associated with ~1 less LY and CHLY, but not a relatively lower \%CHLY. In contrast, having 3+ MBRFs was associated with about 2-3 fewer LYs and CHLYs as well as about 6\% lower \%CHLY (95\% confidence interval: -9.0, -2.5 \%CHLYs), p = 0.001).

CONCLUSIONS: MBRF-related reductions in the cognitive healthspan are most apparent when people have multiple MBRFs. Future research is needed to determine if/how behavioral risks converge mechanistically, and if dementia prevention efficacy improves when targeting MBRF combinations.

}, issn = {1534-7796}, doi = {10.1097/PSY.0000000000001100}, author = {Smagula, Stephen F and Biggs, Mary L and Jacob, Mini E and Rawlings, Andreea M and Odden, Michelle C and Arnold, Alice and Newman, Anne B and Buysse, Daniel J} }