Race differences in emotional adaptation of family caregivers.

OBJECTIVES: This study compares black and white caregivers of persons with Alzheimer's disease (AD) on two general measures of negative and positive emotion (depressive symptoms, positive mood) and two caregiving specific measures of negative and positive emotion (caregiver burden, caregiver satisfaction). We hypothesized that black caregivers would exhibit lower levels of negative emotion and higher levels of positive emotion over time than whites. METHOD: Three hundred ninety-six caregivers were recruited from the Rush Alzheimer's Disease Center in Chicago, Illinois, as part of a longitudinal study of persons with AD. The analyses for this report are based on data from 307 caregivers who were interviewed quarterly over approximately 4 years from 1999 to 2002, an average of nine observations per person. RESULTS: The results showed that black caregivers reported fewer depressive symptoms over time than whites ( beta = -0.14, p < 0.01) but this finding was only for those caregivers living with the care recipient with AD. No race differences were found for measures of positive emotion. CONCLUSION: Our data add to the growing body of evidence that blacks have better emotional outcomes when exposed to the stress of providing informal care to a disabled family member.

Change in direct measures of physical performance among persons with Alzheimer's disease.

OBJECTIVES: Measures of physical performance were used in intact and community populations. We examined upper and lower extremity physical performance tests among people with Alzheimer's disease. METHOD: A total of 367 persons with probable Alzheimer's disease, recruited from an Alzheimer's disease diagnostic center, were given three tests of lower extremity function and two tests of upper extremity function at 6 month intervals for up to 4 years. Gender, race, age and Mini-Mental State Examination (MMSE) score at baseline were used to predict subsequent decline in composite scores of lower and upper extremity function. RESULTS: At baseline, older age and lower MMSE scores were associated with lower scores on both lower and upper extremity function. Males performed better at baseline on lower extremity tests only. For each point higher on MMSE, a person declined 0.023 Standard Unit (SU) less per year (p = 0.0001) on lower extremity tests and declined 0.019 SU less per year (p < 0.0001) on upper extremity tests. CONCLUSION: Physical performance was measured across a range of disease severities and declined over time. Lower cognitive score at baseline predicted faster decline in both lower and upper extremity function. Demographic heterogeneity in decline suggests other predictors may identify factors protective against physical decline.

Losing one's memory in early Alzheimer's disease.

A Heideggerian hermeneutical phenomenological research method was used to investigate the experience of memory loss in twelve individuals with early Alzheimer's disease or mild cognitive impairment. Data analysis proceeded as described by Diekelmann, Allen, and Tanner (1989), and incorporated the methods of Benner (1994), Thomas and Pollio (2002), and van Manen (1990). Three constitutive patterns with relational themes were identified. The first pattern, experiencing breakdown, consisted of two themes: awakening to breakdown and living with forgetting. The second pattern, temporality, consisted of three themes: being in the nothing, forgetting the past, and looking ahead. The third pattern, managing forgetting, consisted of the themes: remembering with cues, writing things down, recognizing what made remembering better or worse, and using laughter. The finding show that early Alzheimer's disease is more than an illness of cognitive losses and that forgetting is significant in light of the meaning that it has within everyday life.

Cognitive decline and survival in Alzheimer's disease.

OBJECTIVE: To test the association of rate of cognitive decline, an indicator of the severity of the underlying disease process, with risk of death in Alzheimer's disease (AD). METHODS: A total of 472 persons with clinically diagnosed AD were recruited from a memory disorders clinic and day care centers in the Chicago area. They completed a uniform clinical evaluation at baseline and a battery of nine cognitive tests at six-month intervals for a mean of about three years. A previously established measure of global cognition was derived from the nine tests. RESULTS: During follow-up, 168 persons (36%) died. In a proportional hazards model that controlled for age, sex, race, education, and baseline level of cognition, individual rate of global cognitive decline, estimated with least squares regression, was linearly related to mortality risk. Thus, a person declining minimally (increase of 0.04 unit per year, 90th percentile) was 2.7 times less likely to die during the study period than a person declining rapidly (decrease of 0.76 unit per year, 10th percentile). Controlling for baseline disability did not substantially affect results. The association of cognitive decline with mortality was substantially stronger for white persons compared to African Americans and in those with less compared to more education. CONCLUSION: The results indicate that the rate at which cognition declines in AD is robustly related to survival.