The Association Between Loneliness and Maladaptive Moods and Beliefs: A Pilot Study in U.S. Veterans.

INTRODUCTION: Loneliness is a powerful predictor of several medical and psychiatric conditions that are highly prevalent in Veterans, including depression and PTSD. Despite this, few studies have examined loneliness in Veterans or how best to intervene upon Veteran loneliness. Additional empirical research is needed in these areas in order to define clear intervention targets and improve Veteran care. MATERIALS AND METHODS: In this pilot study, we used 62 Veterans' self-reported loneliness and symptoms of post-traumatic stress to examine whether specific symptom clusters of post-traumatic stress were associated with greater loneliness. Post-traumatic stress was measured using the PTSD Checklist for DSM-5, and responses were further parsed into four symptom clusters: intrusions, avoidance, negative alterations in mood and cognition (excluding the social withdrawal item), and alterations in arousal and reactivity. RESULTS: Results revealed that only the negative alterations in mood and cognition symptom cluster was associated with increased Veteran loneliness, even after adjusting for sociodemographic factors, social isolation, and symptoms of depression. These analyses were also repeated using a subset of our sample (n = 29) who completed repeated measures of the PTSD Checklist. Results again revealed that the same symptom cluster predicted Veteran loneliness over 1 year later. CONCLUSIONS: This pilot study demonstrates the value of a publicly available PTSD measure for identifying lonely Veterans and highlights how reducing negative alterations in mood and cognition may serve as a potentially critical target for future Veteran loneliness interventions.

A Randomized, Controlled Pilot Study of Mindfulness-Based Stress Reduction in Healthy Older Adults.

OBJECTIVES: As the aging population increases, it is critical to find ways to sustain older adults' health and well-being. Mindfulness-Based Stress Reduction (MBSR) may be one approach, but its effects are difficult to discern because few studies have conducted randomized controlled trials with an active control group and blinded examiners. We begin to address these gaps with a pilot study examining the feasibility of conducting an MBSR intervention with an active control condition in healthy older adults. METHODS: Participants were randomly assigned to one of two classes, MBSR or Brain Health education. Classes were matched for time, format, and instructor. The study examined acceptability, practicality, implementation, and preliminary efficacy using a range of participant questionnaires, instructor ratings, cognitive measures assessed by blinded examiners, and attendance. RESULTS: Both MBSR and the Brain Health class evidenced high rates of recruitment, participant satisfaction, and retention. Implementation procedures were successful, and preliminary results revealed similar levels of efficacy across both classes. CONCLUSIONS: This study demonstrates the feasibility of an MBSR intervention in healthy older adults. CLINICAL IMPLICATIONS: MBSR, with its focus on improving stress and self-awareness, has the potential to be an approach that can improve aging adults' health and coping skills.

Cultural differences in caring for people with dementia: a pilot study of concern about losing face and loneliness in Chinese American and European American caregivers.

OBJECTIVES: Heavy demands upon dementia caregivers can lead to a number of poor health outcomes including declines in physical, mental, and brain health. Although dementia affects people from all backgrounds, research in the US has largely focused on European American caregivers. This has made providing culturally-competent care more difficult. This study begins to address this issue by empirically examining how culturally-shaped beliefs can influence loneliness in family caregivers of people with dementia. METHODS: We conducted a preliminary questionnaire study with Chinese American and European American family caregivers of people with dementia (N = 72). RESULTS: Chinese American caregivers were more concerned than European American caregivers about losing face, which in turn, was associated with greater loneliness. This pattern remained when accounting for caregiver gender, age, and relationship to the person with dementia. CONCLUSIONS: These preliminary findings highlight the role that cultural beliefs can play in adverse caregiver outcomes, and suggest that addressing concerns about losing face may be an important way for healthcare providers to help reduce loneliness among Chinese American caregivers. CLINICAL IMPLICATIONS: Understanding how cultural beliefs influence caregiver outcomes is critical as healthcare professionals work to provide culturally-competent care and design culturally-sensitive interventions.

Diminished preparatory physiological responses in frontotemporal lobar degeneration syndromes.

Researchers typically study physiological responses either after stimulus onset or when the emotional valence of an upcoming stimulus is revealed. Yet, participants may also respond when they are told that an emotional stimulus is about to be presented even without knowing its valence. Increased physiological responding during this time may reflect a 'preparation for action'. The generation of such physiological responses may be supported by frontotemporal regions of the brain that are vulnerable to damage in frontotemporal lobar degeneration. We examined preparatory physiological responses and their structural and functional neural correlate in five frontotemporal lobar degeneration clinical subtypes (behavioural variant frontotemporal dementia, n = 67; semantic variant primary progressive aphasia, n = 35; non-fluent variant primary progressive aphasia, n = 30; corticobasal syndrome, n = 32; progressive supranuclear palsy, n = 30). Comparison groups included patients with Alzheimer's disease (n = 56) and healthy controls (n = 35). Preparatory responses were quantified as cardiac interbeat interval decreases (i.e. heart rate increases) from baseline to an 'instruction period', during which participants were told to watch the upcoming emotional film but not provided the film's valence. Patients' behavioural symptoms (apathy and disinhibition) were also evaluated via a caregiver-reported measure. Compared to healthy controls and Alzheimer's disease, the frontotemporal lobar degeneration group showed significantly smaller preparatory responses. When comparing each frontotemporal lobar degeneration clinical subtype with healthy controls and Alzheimer's disease, significant group differences emerged for behavioural variant frontotemporal dementia and progressive supranuclear palsy. Behavioural analyses revealed that frontotemporal lobar degeneration patients showed greater disinhibition and apathy compared to Alzheimer's disease patients. Further, these group differences in disinhibition (but not apathy) were mediated by patients' smaller preparatory responses. Voxel-based morphometry and resting-state functional MRI analyses revealed that across patients and healthy controls, smaller preparatory responses were associated with smaller volume and lower functional connectivity in a circuit that included the ventromedial prefrontal cortex and cortical and subcortical regions of the salience network. Diminished preparatory physiological responding in frontotemporal lobar degeneration may reflect a lack of preparation for actions that are appropriate for an upcoming situation, such as approaching or withdrawing from emotional stimuli. The ventromedial prefrontal cortex and salience network are critical for evaluating stimuli, thinking about the future, triggering peripheral physiological responses, and processing and interpreting interoceptive signals. Damage to these circuits in frontotemporal lobar degeneration may impair preparatory responses and help explain often-observed clinical symptoms such as disinhibition in these patients.

BCG vaccination at birth and COVID-19: a case-control study among U.S. military Veterans.

In the early stages of the COVID-19 global pandemic, caused by the SARS-CoV-2 virus, low- and middle-income countries (LMICs) appeared to be experiencing lower morbidity and mortality rates than high-income countries, particularly the United States. Various suggestions put forward to account for this included the possibility that LMICs might be experiencing off-target benefits of infant vaccination with BCG, intended primarily to protect against tuberculosis. A number of ecologic epidemiological studies that considered COVID-19 morbidity and mortality rates across countries appeared to support this suggestion. Ecologic studies, however, are primarily hypothesis-generating, given their well-known limitations in extrapolating to the individual-person level. The present study, which employed anonymized records of U.S. Military Veterans treated by the Department of Veterans Affairs was principally a case-control study of COVID-19 infections with a retrospective cohort study of mortality nested within the infections. Controls were a random sample of Veterans not recorded as having had COVID-19. There were 263,039 controls and 167,664 COVID-19 cases, of whom 5,016 died. The combination of country and year of birth was used as a surrogate for infant BCG vaccination. The study did not support the hypothesis that BCG in infancy was protective against COVID-19. The odds ratio for infection was 1.07 (95% confidence interval [CI]: 1.03, 1.11) and the risk ratio for mortality among the COVID-19 cases was 0.86 (95% CI: 0.63, 1.18). The potential for non-differential exposure misclassification was a concern, possibly biasing measures of association toward the null value.

PLAIN LANGUAGE SUMMARYLow- and middle-income countries (LMICs) have appeared to be much less affected by the COVID-19 pandemic, caused by the SARS-CoV-2 virus, than might have been expected from the effects of the virus in more-developed countries. It has been suggested that BCG vaccination of infants against tuberculosis in LMICs might be providing cross-protection against COVID-19. BCG has never been routinely administered in the United States and is not currently administered in most other developed countries.Some epidemiology studies, known as "ecologic" studies have provided support for the idea that BCG is protecting against COVID-19. However, ecologic studies, with group (i.e., country) measures of exposure and health outcomes, are difficult to interpret in terms of cause and effect.More interpretable are studies that use individual-person measures of exposure and health outcome. We carried out such a study using data from several hundred-thousand U.S. military Veterans, many of whom were born in LMICs and would have received BCG vaccination as infants. Many U.S. Veterans have had COVID-19, and many of those have died of it.Our study, the first of its kind, found no evidence to support the idea that infant BCG vaccination protects against infection or death from COVID-19.

Auditory Comprehension Deficits in Post-stroke Aphasia: Neurologic and Demographic Correlates of Outcome and Recovery.

Introduction: One of the most challenging symptoms of aphasia is an impairment in auditory comprehension. The inability to understand others has a direct impact on a person's quality of life and ability to benefit from treatment. Despite its importance, limited research has examined the recovery pattern of auditory comprehension and instead has focused on aphasia recovery more generally. Thus, little is known about the time frame for auditory comprehension recovery following stroke, and whether specific neurologic and demographic variables contribute to recovery and outcome. Methods: This study included 168 left hemisphere chronic stroke patients stroke patients with auditory comprehension impairments ranging from mild to severe. Univariate and multivariate lesion-symptom mapping (LSM) was used to identify brain regions associated with auditory comprehension outcomes on three different tasks: Single-word comprehension, yes/no sentence comprehension, and comprehension of sequential commands. Demographic variables (age, gender, and education) were also examined for their role in these outcomes. In a subset of patients who completed language testing at two or more time points, we also analyzed the trajectory of recovery in auditory comprehension using survival curve-based time compression. Results: LSM analyses revealed that poor single-word auditory comprehension was associated with lesions involving the left mid- to posterior middle temporal gyrus, and portions of the angular and inferior-middle occipital gyri. Poor yes/no sentence comprehension was associated almost exclusively with the left mid-posterior middle temporal gyrus. Poor comprehension of sequential commands was associated with lesions in the left posterior middle temporal gyrus. There was a small region of convergence between the three comprehension tasks, in the very posterior portion of the left middle temporal gyrus. The recovery analysis revealed that auditory comprehension scores continued to improve beyond the first year post-stroke. Higher education was associated with better outcome on all auditory comprehension tasks. Age and gender were not associated with outcome or recovery slopes. Conclusions: The current findings suggest a critical role for the posterior left middle temporal gyrus in the recovery of auditory comprehension following stroke, and that spontaneous recovery of auditory comprehension can continue well beyond the first year post-stroke.

Smaller Volume in Left-Lateralized Brain Structures Correlates with Greater Experience of Negative Non-target Emotions in Neurodegenerative Diseases.

Subjective emotional experience that is congruent with a given situation (i.e., target emotions) is critical for human survival (e.g., feeling disgusted in response to contaminated food motivates withdrawal behaviors). Neurodegenerative diseases including frontotemporal dementia and Alzheimer's disease affect brain regions critical for cognitive and emotional functioning, resulting in increased experience of emotions incongruent with the situation (i.e., non-target emotions, such as feeling happy when seeing someone grieving). We examined neuroanatomical correlates of subjective experience of non-target emotions in 147 patients with neurodegenerative diseases and 26 healthy individuals. Participants watched three films intended to elicit particular target emotions and rated their experience of negative and positive target and non-target emotions after watching each film. We found that smaller volume in left hemisphere regions (e.g., caudate, putamen, and dorsal anterior insula) was associated with greater experience of negative non-target emotions. Follow-up analyses confirmed that these effects were left-lateralized. No correlates emerged for positive non-target emotions. These findings suggest that volume loss in left-hemisphere regions produces a more diffuse, incongruent experience of non-target emotions. These findings provide a potential neuroanatomical basis for understanding how subjective emotional experience is constructed in the brain and how this can be disrupted in neurodegenerative disease.

Pronoun Use during Patient-Caregiver Interactions: Associations with Caregiver Well-Being.

INTRODUCTION: Caring for a spouse with dementia can be extremely challenging. Many caregivers experience profound declines in well-being; however, others remain healthy. OBJECTIVE: This study determined whether the personal pronouns used in interactions between persons with dementia (PWDs) and their spousal caregivers were associated with caregiver well-being. METHODS: Fifty-eight PWDs and their spousal caregivers engaged in a 10-min conversation about an area of disagreement in a laboratory setting. Verbatim transcripts of the conversation were coded using text analysis software, and caregivers and PWDs each received scores for (a) I-pronouns, (b) you-pronouns, and (c) we-pronouns. Caregivers' well-being was assessed using a composite measure of depression, anxiety, burden, and strain. RESULTS: Results revealed that less use of we-pronouns by caregivers and PWDs and greater use of I-pronouns by PWDs were -associated with lower caregiver well-being. CONCLUSIONS: These findings indicate that less use of pronouns that refer to the couple (we-pronouns used by either partner) and greater use of pronouns that refer to the PWD (I-pronouns used by the PWD) are indicative of caregivers at heightened risk for lower well-being.

Age-related changes in emotional behavior: Evidence from a 13-year longitudinal study of long-term married couples.

We examined age-related changes in emotional behavior in a sample of middle-aged and older long-term married couples over a 13-year period. Data were collected at 3 waves, each occurring 5 to 6 years apart. For the present study, only couples who participated in all 3 waves were examined (n = 87). Couples were either in the middle-aged group (40-50 years old, married at least 15 years) or the older group (60-70 years old, married at least 35 years). At each wave, couples engaged in 15-min unrehearsed conversations about an area of disagreement in their marriage. Emotional behaviors during the conversation were objectively coded using the Specific Affect Coding System. Latent growth curve analyses revealed that, for both husbands and wives, negative emotional behavior (primarily belligerence, defensiveness, fear/tension, and whining) decreased and positive emotional behavior (primarily humor, enthusiasm, and validation) increased with age. Findings generalized across middle-aged and older cohorts and levels of marital satisfaction. These findings support theories that suggest that positive emotion increases and negative emotion decreases with age, expanding upon previous findings by examining objectively coded emotional behaviors longitudinally in an interpersonal context. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Responding to the emotions of others: Age differences in facial expressions and age-specific associations with relational connectedness.

Responding prosocially to the emotion of others may become increasingly important in late life, especially as partners and friends encounter a growing number of losses, challenges, and declines. Facial expressions are important avenues for communicating empathy and concern, and for signaling that help is forthcoming when needed. In a study of young, middle-aged, and older adults, we measured emotional responses (facial expressions, subjective experience, and physiological activation) to a sad, distressing film clip and a happy, uplifting film clip. Results revealed that, relative to younger adults, older adults showed more sadness and confusion/concern facial expressions during the distressing film clip. Moreover, for older adults only, more sadness and fewer disgust facial expressions during the distressing film clip were associated with higher levels of relational connectedness. These findings remained stable when accounting for subjective emotional experience, physiological activation, and trait empathy in response to the film clip. When examining the uplifting film clip, older adults showed more happiness facial expressions relative to younger adults at trend levels. More facial expressions of happiness were associated with higher levels of relational connectedness, but unlike the effect of sadness expressions, this was not moderated by age. These findings underscore an important adaptive social function of facial expressions-particularly in response to the distress of others-in late life. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Ten-Year Prevalence of Cognitive Impairment Diagnoses and Associated Medical and Psychiatric Conditions in a National Cohort of Older Female Veterans.

OBJECTIVE: Veterans are at risk for dementia because of elevated general risk factors and exposure to military risk factors; however, few studies have focused on female veterans despite their growing numbers. We sought to characterize the 10-year prevalence of cognitive impairment (i.e., mild cognitive impairment and dementia) and associated conditions in older female veterans. METHODS: Data were extracted from Veterans Health Administration medical records of 168,111 female veterans aged 65 and older. Cognitive impairment (CI) diagnoses were defined using International Classification of Diseases, Ninth Revision (ICD-9) codes or dementia medication prescriptions. Medical comorbidities and psychiatric conditions were determined using ICD-9 codes occurring within 2years of CI diagnosis or the last recorded medical encounter for veterans without CI. RESULTS: Ten-year prevalence was 1.8% (3,075) for mild cognitive impairment (MCI) diagnoses and 8.1% (13,653) for dementia diagnoses. Prevalence increased with age (MCI age 65: 1.4%; age 85+: 2.7%; dementia age 65: 2.5%; age 85+: 17.7%); 37.3% had dementia subtype diagnoses, with Alzheimer's disease being the most prevalent (72.7%). 47.7% of veterans with CI had at least one medical comorbidity, whereas 22.5% had at least one psychiatric condition. CONCLUSION: Few studies have characterized the prevalence of cognitive impairment in female veterans despite the expected increases in CI and impending demographic shifts in the military. The high prevalence of medical and psychiatric conditions in female veterans with CI highlights their healthcare burden and emphasizes the need for further investigations into the prevention, treatment, and care of cognitive impairment in this understudied population.

Genuine Smiles by Patients During Marital Interactions are Associated with Better Caregiver Mental Health.

OBJECTIVE: Providing care for a spouse with dementia is associated with an increased risk for poor mental health. To determine whether this vulnerability in caregivers is related to the expression of positive emotion, we examined 57 patients with Alzheimer's disease and behavioral variant frontotemporal dementia and their spouses as they discussed a marital conflict. METHOD: Facial behavior during the discussion was objectively coded to identify Duchenne (i.e., genuine) smiles and non-Duchenne (i.e., polite) smiles. Caregiver mental health was measured using the Medical Outcomes Survey. RESULTS: Greater expression of Duchenne smiles by patients was associated with better caregiver mental health, even when accounting for covariates (i.e., diagnosis, patient cognitive functioning, and caregiver marital satisfaction). Greater expression of non-Duchenne smiles by patients was associated with worse caregiver health, but only when covariates were entered in the model. Expression of Duchenne and non-Duchenne smiles by caregivers was not associated with caregiver mental health. DISCUSSION: Patients' expression of Duchenne and non-Duchenne smiles may reveal important aspects of the emotional quality of the patient-caregiver relationship that influence caregiver burden and mental health.

Physiological, behavioral and subjective sadness reactivity in frontotemporal dementia subtypes.

Frontotemporal dementia (FTD), a neurodegenerative disease broadly characterized by socioemotional impairments, includes three clinical subtypes: behavioral variant FTD (bvFTD), semantic variant primary progressive aphasia (svPPA) and non-fluent variant primary progressive aphasia (nfvPPA). Emerging evidence has shown emotional reactivity impairments in bvFTD and svPPA, whereas emotional reactivity in nfvPPA is far less studied. In 105 patients with FTD (49 bvFTD, 31 svPPA and 25 nfvPPA) and 27 healthy controls, we examined three aspects of emotional reactivity (physiology, facial behavior and subjective experience) in response to a sad film. In a subset of the sample, we also examined the neural correlates of diminished aspects of reactivity using voxel-based morphometry. Results indicated that all three subtypes of FTD showed diminished physiological responding in respiration rate and diastolic blood pressure; patients with bvFTD and svPPA also showed diminished subjective experience, and no subtypes showed diminished facial behavior. Moreover, there were differences among the clinical subtypes in brain regions where smaller volumes were associated with diminished sadness reactivity. These results show that emotion impairments extend to sadness reactivity in FTD and underscore the importance of considering different aspects of sadness reactivity in multiple clinical subtypes for characterizing emotional deficits and associated neurodegeneration in FTD.

Military-related risk factors in female veterans and risk of dementia.

OBJECTIVE: To determine whether diagnoses of traumatic brain injury (TBI), posttraumatic stress disorder (PTSD), and depression, alone or in combination, increase dementia risk among older female veterans. METHODS: This cohort study included data from 109,140 female veterans ≥55 years of age receiving care from Veterans Health Administration medical centers in the United States between October 2004 and September 2015 with at least 1 follow-up visit. TBI, PTSD, depression, and medical conditions at study baseline and incident dementia were determined according to ICD-9-CM codes. Fine-Gray proportional hazards models were used to determine the association between military-related risk factors and dementia diagnosis, accounting for the competing risk of death. RESULTS: During follow-up (mean 4.0 years, SD 2.3), 4% of female veterans (n = 4,125) developed dementia. After adjustment for demographics and medical conditions, women with TBI, PTSD, and depression had a significant increase in risk of developing dementia compared to women without these diagnoses (TBI-adjusted subdistribution hazard ratio [adjusted sHR] 1.49, 95% confidence interval [CI] 1.01-2.20; PTSD adjusted sHR 1.78, 95% CI 1.34-2.36; and depression-adjusted sHR 1.67, 95% CI 1.55-1.80), while women with >1 diagnosis had the highest risk for dementia (adjusted sHR 2.15, 95% CI 1.84-2.51). CONCLUSIONS: We found that women with military-related risk factors had an ≈50% to 80% increase in developing dementia relative to women without these diagnoses, while female veterans with multiple risk factors had a >2-fold risk of developing dementia. These findings highlight the need for increased screening of TBI, PTSD, and depression in older women, especially female veterans.

Network Architecture Underlying Basal Autonomic Outflow: Evidence from Frontotemporal Dementia.

The salience network is a distributed neural system that maintains homeostasis by regulating autonomic nervous system activity and social-emotional function. Here we examined how within-network connectivity relates to individual differences in human (including males and females) baseline parasympathetic and sympathetic nervous activity. We measured resting autonomic nervous system physiology in 24 healthy controls and 23 patients with behavioral variant frontotemporal dementia (bvFTD), a neurodegenerative disease characterized by baseline autonomic deficits. Participants also underwent structural and task-free fMRI. First, we used voxel-based morphometry to determine whether salience network atrophy was associated with lower baseline respiratory sinus arrhythmia (a parasympathetic measure) and skin conductance level (a sympathetic measure) in bvFTD. Next, we examined whether functional connectivity deficits in 21 autonomic-relevant, salience network node-pairs related to baseline autonomic dysfunction. Lower baseline respiratory sinus arrhythmia was associated with smaller volume in left ventral anterior insula (vAI), weaker connectivity between bilateral vAI and bilateral anterior cingulate cortex (ACC), and stronger connectivity between bilateral ACC and bilateral hypothalamus/amygdala. Lower baseline skin conductance level, in contrast, was associated with smaller volume in inferior temporal gyrus, dorsal mid-insula, and hypothalamus; weaker connectivity between bilateral ACC and right hypothalamus/amygdala; and stronger connectivity between bilateral dorsal anterior insula and periaqueductal gray. Our results suggest that baseline parasympathetic and sympathetic tone depends on the integrity of lateralized salience network hubs (left vAI for parasympathetic and right hypothalamus/amygdala for sympathetic) and highly calibrated ipsilateral and contralateral network connections. In bvFTD, deficits in this system may underlie resting parasympathetic and sympathetic disruption.SIGNIFICANCE STATEMENT The salience network maintains homeostasis and regulates autonomic nervous system activity. Whether within-network connectivity patterns underlie individual differences in resting parasympathetic and sympathetic nervous system activity, however, is not well understood. We measured baseline autonomic nervous system activity in healthy controls and patients with behavioral variant frontotemporal dementia, a neurodegenerative disease characterized by resting autonomic deficits, and probed how salience network dysfunction relates to diminished parasympathetic and sympathetic outflow. Our results indicate that baseline parasympathetic and sympathetic tone are the product of complex, opposing intranetwork nodal interactions and depend on the integrity of highly tuned, lateralized salience network hubs (i.e., left ventral anterior insula for parasympathetic activity and right hypothalamus/amygdala for sympathetic activity).

The cost of believing emotions are uncontrollable: Youths' beliefs about emotion predict emotion regulation and depressive symptoms.

As humans, we have a unique capacity to reflect on our experiences, including emotions. Over time, we develop beliefs about the nature of emotions, and these beliefs are consequential, guiding how we respond to emotions and how we feel as a consequence. One fundamental belief concerns the controllability of emotions: Believing emotions are uncontrollable (entity beliefs) should reduce the likelihood of trying to control emotional experiences using effective regulation strategies like reappraisal; this, in turn, could negatively affect core indices of psychological health, including depressive symptoms. This model holds particular relevance during youth, when emotion-related beliefs first develop and stabilize and when maladaptive beliefs could contribute to emerging risk for depression. In the present investigation, a pilot diary study (N = 223, aged 21-60) demonstrated that entity beliefs were associated with using reappraisal less in everyday life, even when controlling for possible confounds (i.e., self-efficacy, pessimism, stress exposure, stress reactivity). Then, two studies examined whether entity beliefs and associated impairments in reappraisal may set youths on a maladaptive trajectory: In a cross-sectional study (N = 136, aged 14-18), youths with stronger entity beliefs experienced greater depressive symptoms, and this link was mediated by lower reappraisal. This pattern was replicated and extended in a longitudinal study (N = 227, aged 10-18), wherein youth- and parent-reported depressive symptoms were assessed 18 months after assessing beliefs. These results suggest that entity beliefs about emotion constitute a risk factor for depression that acts via reappraisal, adding to the growing literature on emotion beliefs and their consequences for self-regulation and health. (PsycINFO Database Record

Empathic Accuracy Deficits in Patients with Neurodegenerative Disease: Association with Caregiver Depression.

OBJECTIVES: To investigate whether deficits in empathic accuracy (i.e., ability to recognize emotion in others) in patients with neurodegenerative disease are associated with greater depression in their caregivers. DESIGN: Two cross-sectional studies. SETTING: Academic medical center and research university. PARTICIPANTS: Two independent samples (N = 172, N = 63) of patients with a variety of neurodegenerative diseases and their caregivers; comparison group of healthy couples. MEASUREMENT: Patients' empathic accuracy was assessed in the laboratory using a novel dynamic tracking task (rating another person's changing emotions over time) and more traditional measures (recognizing the emotion expressed in photographs of facial expressions and by characters in films). Caregivers completed self-report inventories of depression. RESULTS: Lower empathic accuracy in patients was associated with greater depression in caregivers in both studies. In study 1, this association was found when empathic accuracy was measured using the dynamic tracking measure but not when measured using the more traditional photograph and film measures. In study 2, we found preliminary support for our theoretical model wherein lower empathic accuracy in patients is associated with increased caregiver stress (loneliness, strain, and burden), which in turn is associated with greater caregiver depression. CONCLUSIONS: Caring for a patient with deficits in empathic accuracy is associated with greater loneliness, strain, and burden for caregivers, and increased depression. Caregivers may benefit from interventions designed to compensate for the stress and interpersonal loss associated with patients' declining empathic accuracy.

Greater Experience of Negative Non-Target Emotions by Patients with Neurodegenerative Diseases Is Related to Lower Emotional Well-Being in Caregivers.

BACKGROUND: Behavioral symptoms in patients with neurodegenerative diseases can be particularly challenging for caregivers. Previously, we reported that patients with frontotemporal dementia (FTD) and Alzheimer's disease (AD) experienced emotions that were atypical or incongruent with a given situation (i.e., non-target emotions). AIM: We tested the hypothesis that greater experience of non-target emotions by patients is associated with lower caregiver emotional well-being. METHODS: 178 patients with FTD, AD, or other neurodegenerative diseases and 35 healthy individuals watched 3 films designed to induce amusement, sadness, and disgust, and then reported their emotions during the films. Caregivers of the patients reported their own emotional well-being on the Medical Outcomes Study 36-item Short-Form Health Survey. RESULTS: In response to the amusement and sadness (but not disgust) films, greater experience of non-target emotions by patients was related to lower caregiver emotional well-being. These effects were specific to patients' experience of negative non-target emotions (i.e., not found for positive non-target emotions or for negative or positive target emotions). CONCLUSION: The findings reveal a previously unstudied patient behavior that is related to worse caregiver emotional well-being. Future research and clinical assessment may benefit from evaluating non-target emotions in patients.

Poor caregiver mental health predicts mortality of patients with neurodegenerative disease.

Dementia and other neurodegenerative diseases cause profound declines in functioning; thus, many patients require caregivers for assistance with daily living. Patients differ greatly in how long they live after disease onset, with the nature and severity of the disease playing an important role. Caregiving can also be extremely stressful, and many caregivers experience declines in mental health. In this study, we investigated the role that caregiver mental health plays in patient mortality. In 176 patient-caregiver dyads, we found that worse caregiver mental health predicted greater patient mortality even when accounting for key risk factors in patients (i.e., diagnosis, age, sex, dementia severity, and patient mental health). These findings highlight the importance of caring for caregivers as well as patients when attempting to improve patients' lives.

Increased subjective experience of non-target emotions in patients with frontotemporal dementia and Alzheimer's disease.

Although laboratory procedures are designed to produce specific emotions, participants often experience mixed emotions (i.e., target and non-target emotions). We examined non-target emotions in patients with frontotemporal dementia (FTD), Alzheimer's disease (AD), other neurodegenerative diseases, and healthy controls. Participants watched film clips designed to produce three target emotions. Subjective experience of non-target emotions was assessed and emotional facial expressions were coded. Compared to patients with other neurodegenerative diseases and healthy controls, FTD patients reported more positive and negative non-target emotions, whereas AD patients reported more positive non-target emotions. There were no group differences in facial expressions of non-target emotions. We interpret these findings as reflecting deficits in processing interoceptive and contextual information resulting from neurodegeneration in brain regions critical for creating subjective emotional experience.