Thesis Format Tutorial

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Stress-Related Cognitive Impairment
Among Palliative Caregivers
Corey Mackenzie, Ph.D., C. Psych
2
Objectives

• Brief overview of caregiver stress
• Stress-related cognitive impairment
• Implications of poor cognition for caregivers
• Concluding remarks and future directions

3
Causes of Caregiver Stress
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Causes of Caregiver Stress
Caregiver Health
Existential Issues
Resources
Other Stressors
Disease
CAREGIVER STRESS
Caregiver Coping Style
Pain Suffering
Family Dynamics
Social Support
Caregiver Personality
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Consequences of Caregiver Stress
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Mental Health Consequences

• Although caregiving can be rewarding, it also has
  well-documented negative effects
• Caregivers have
• High rates of perceived stress (g .55)
• Elevated rates of clinical depression (g .58)
• Low rates of self-efficacy confidence (g
  -.54)
• Low levels of well-being (g -.40)

Pinquart Sorensen (2003) Psychology Aging
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Health Consequences
Vitaliano et al. (2003) Psychological Bulletin
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Health Consequences
Distress
10-12 higher rates of med use and illness
Physiological Response
Stressors
Health Habits
Vitaliano et al. (2003) Psychological Bulletin
9
Health Consequences
Distress
23 higher levels of stress hormones
Physiological Response
Stressors
Health Habits
Vitaliano et al. (2003) Psychological Bulletin
10
Health Consequences
Distress
63 higher risk of mortality for spouses
Physiological Response
Stressors
Health Habits
Schulz Beach (1999) JAMA
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Cognitive Consequences of Stress
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Does stress impair caregiver cognition?

• Acute stress impairs a wide range of cognitive
  abilities, including attention, learning, and
  memory

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Does stress impair caregiver cognition?

• Life even stress impairs problem solving and
  decision making (e.g., Klein Barnes, 1994)

14
Why would stress impair memory?

• Hypothesis 1 Intrusive thoughts occupy space in
  WM

15
Why would stress impair memory?

• Hypothesis 2 Stress-related brain damage

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Caregiver Cognition

• Caswell et al. (2003)
• 44 spouse caregivers versus 66 matched controls
• Caregivers did more poorly on the Digit Symbol
  Test
• Lee et al. (2004)
• 11,000 caregivers of ill spouses performed more
  poorly than controls on a 10-item memory test
• Vitaliano et al. (2005)
• 96 spouse caregivers versus 95 matched controls
• Significant decline in memory over 2 years
• Mediated by hostility and metabolic risk factors

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What about palliative caregivers?

• We examined cognition among 27 caregivers
  providing palliative care at home to family
  members
• We assessed
• Intelligence (WASI)
• Episodic Memory (CVLT Logical Memory)
• Working Memory (WMS Working Memory Index)
• Attention (Ruff 2 7)
• Mood (BDI STAI)
• We compared caregivers performance to normative
  data for each neuropsychological test

Mackenzie et al. (2007) J of Palliative Medicine
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Cognitive Consequences
Learning Short-term
Memory Working Memory
Mackenzie et al. (2007) J of Palliative Medicine
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Implications
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Consequences of Poor Caregiver Cognition

• Complex caregiving requirements
• Manage household tasks
• Schedule, coordinate, and remember appointments
• Medication management
• Organize, coordinate, and administer multiple
  drugs in distracting environments throughout the
  day
• Family finances legal decisions
• Managing other work and family responsibilities

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What should we do?

• Educate caregivers about this change
• Stress impairs attention and memory
• Importance of managing stress
• Education for health professionals working with
  caregivers
• Implications for interventions focusing on
  caregivers

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Concluding Remarks
corey_mackenzie_at_umanitoba.ca