Predicting depression in dementia caregivers: do religious/spiritual struggles play a role?

OBJECTIVES: Using a stress process framework model, the goal of this study was to address the current gap in our understanding of the prevalence and predictive power of specific types of religious/spiritual struggles for mental health outcomes in informal dementia caregivers. METHOD: A convenience sample of 156 informal dementia caregivers completed a scale measuring six domains of religious/spiritual struggles, as well as other measures of primary stressors, background/contextual variables, and mental health outcome (depression). RESULTS: Overall levels of religious/spiritual struggle were low, but 26 percent of the sample were classified as possible cases of clinically significant religious/spiritual struggle for at least one of the six domains. Of this group, 49 percent acknowledged struggles with ultimate meaning. Religious/spiritual struggles predicted greater self-reported depression over and above number of care recipient problem behaviors (primary stressor), caregiver sex, and caregiver personality (i.e. emotional stability). Although no individual domain of religious/spiritual struggle emerged as most salient, caregivers reported significantly more ultimate meaning struggles than demonic or interpersonal struggles. CONCLUSION: Consistent with the stress process framework model, religious/spiritual struggles appeared to operate as a secondary stressor for informal dementia caregivers, adding predictive power to background/contextual factors and to primary stressors for the measured outcome of self-reported depression. One-fourth of the sample self-reported potentially clinically significant religious/spiritual struggles, with ultimate meaning struggles most commonly reported. Further research in this area may advance efforts to better equip both secular and religious professionals to provide evidence-based counsel to informal dementia caregivers.

The Multidimensional Orientation Toward Dying and Death Inventory (MODDI-F): Factorial Validity and Reliability in a U.S. Sample.

CONTEXT: Death anxiety has been hypothesized to be a transdiagnostic construct, meaning that the fear of death may increase one's vulnerability to the development or maintenance of a number of psychological disorders. As such, effective and efficient measurement of this construct becomes a priority for hospice and palliative medicine specialists. The Multidimensional Orientation Toward Dying and Death Inventory (MODDI-F) is the only factor-analytically constructed multidimensional scale with a conceptual rationale that measures both the fear and acceptance of dying and death. OBJECTIVES: To determine the factor structure of the MODDI-F with an English-speaking sample, so as to expand the scale's potential for use in hospice and palliative medicine, clinical psychology, and thanatology research. METHODS: Participants comprise a random sample of 404 adults ranging in age from 20 to 85, stratified by sex, age, and ethnicity. They completed the 47-item MODDI-F/eng and were contacted five months later for a test-retest follow-up survey. RESULTS: Although confirmatory factor analyses did not fit the models previously found for the German- and Chinese-language versions of the MODDI-F, exploratory factor analyses resulted in a five-factor fear dimension and a two-factor acceptance dimension that were empirically and conceptually similar to the German- and Chinese-language versions. Additional psychometric analyses yielded evidence for the internal consistency reliability, five-month test-retest reliability, and construct validity of the seven-factor scores of the English-language MODDI-F. CONCLUSION: The results from this psychometric investigation of the English-language version of the MODDI-F are promising and warrant further investigation with clinical populations in hospice and palliative care settings.

Subjective Cognitive Complaints in Parkinson Disease Without Dementia: A Preliminary Study.

Little is known about the subjective cognitive complaints of individuals with Parkinson disease (PD). Such complaints have become a topic of interest recently as they play a role in the diagnosis of neurocognitive disorders. The aim of this preliminary study was to determine whether a sample of nondemented individuals with PD reported significantly more difficulties with multiple elements of cognition than a control sample and to assess the relation between their ratings and demographics, motor symptom severity, neuropsychological test performance, and measures of depression and anxiety. Forty nondemented individuals with PD and 27 healthy individuals completed a questionnaire assessing everyday cognitive difficulties. Independent t tests indicated that individuals with PD reported significantly more cognitive complaints in general and in specific tasks involving complex attention, executive function, processing speed, and verbal fluency but not memory. Questionnaire ratings significantly correlated with measures assessing anxiety, verbal memory, processing speed, and verbal fluency. Results suggest that it is important to ask individuals with PD about cognitive complaints across several cognitive domains and also inquire about symptoms of anxiety, which may be related to their self-reported cognitive difficulties.

The brief cognitive assessment tool (BCAT): cross-validation in a community dwelling older adult sample.

ABSTRACT Background: Cognitive impairment is underrecognized and misdiagnosed among community-dwelling older adults. At present, there is no consensus about which cognitive screening tool represents the "gold standard." However, one tool that shows promise is the Brief Cognitive Assessment Tool (BCAT), which was originally validated in an assisted living sample and contains a multi-level memory component (e.g. word lists and story recall items) and complex executive functions features (e.g. judgment, set-shifting, and problem-solving). Methods: The present study cross-validated the BCAT in a sample of 75 community-dwelling older adults. Participants completed a short battery of several individually administered cognitive tests, including the BCAT and the Montreal Cognitive Assessment (MoCA). Using a very conservative MoCA cut score of <26, the base rate of cognitive impairment in this sample was 35%. Results: Adequate internal consistency and strong evidence of construct validity were found. A receiver operating characteristic (ROC) curve was calculated from sensitivity and 1-specificity values for the classification of cognitively impaired versus cognitively unimpaired. The area under the ROC curve (AUC) for the BCAT was .90, p < 0.001, 95% CI [0.83, 0.97]. A BCAT cut-score of 45 (scores below 45 suggesting cognitive impairment) resulted in the best balance between sensitivity (0.81) and specificity (0.80). Conclusions: A BCAT cut-score can be used for identifying persons to be referred to appropriate healthcare professionals for more comprehensive cognitive assessment. In addition, guidelines are provided for clinicians to interpret separate BCAT memory and executive dysfunction component scores.

Preliminary investigation of the Kitchen Picture Test (KPT): a new screening test of practical judgment for older adults.

Judgment is widely recognized as an important executive function, and deficits in judgment can lead to health risks, safety concerns, and hospitalizations. Surprisingly, relatively few tests of judgment have been developed specifically for older adults--a population particularly vulnerable to executive and functional declines. The Kitchen Picture Test (KPT) is a new screening measure of practical judgment. In two independent studies (Study 1, N = 99 nursing home patients; Study 2, N = 163 nursing home and assisted living patients), psychometric analyses confirmed strong evidence for reliability, construct validity, and predictive validity. A receiver operating characteristic (ROC) curve was calculated from sensitivity and 1-specificity values for diagnoses of dementia versus no dementia. A KPT cut score can be used for identifying persons to be referred to appropriate health-care professionals who have specific expertise in the evaluation and treatment of cognitive impairment.

The Judgment Test of the Neuropsychological Assessment Battery (NAB): psychometric considerations in an assisted-living sample.

A total of 82 older adults recruited from assisted-living facilities completed the Judgment subtest of the Neuropsychological Assessment Battery. The internal consistency reliability of Judgment scores in this sample, as estimated by Cronbach's α, was .83. Significant and strong Judgment score correlations with measures of general cognitive functioning and instrumental activities of daily living provided evidence of construct validity. Furthermore, participants who exhibited the capacity to consent to the evaluation performed significantly better on the Judgment subtest than did participants who did not exhibit consent capacity. Finally, Judgment scores predicted a significant proportion of variance in both instrumental and basic activities of daily living over and above the variance accounted for by scores on measures of general cognitive functioning and executive functioning. This study presents promising preliminary evidence of the incremental validity of Judgment subtest scores for predicting both basic and instrumental activities of daily living in an assisted-living sample.

Development and validation of the short form of the Brief Cognitive Assessment Tool (BCAT-SF).

This article describes the development and validation of a short form of the Brief Cognitive Assessment Tool (BCAT), the BCAT-SF. Frontline providers and many specialists report having little time to assess cognitive functioning, despite recognizing the utility of doing so. Many of the screening tools now available are judged to require too much time to administer. With this in mind, our intent was to design a very brief measure that retained much of the excellent psychometric properties of the original 21-item BCAT. We present a comparison of the evidence for the reliability and validity of the scores from the original and short forms of the BCAT. One hundred four older adults referred for neuropsychological evaluation participated in the study. We used a rational approach to select items from the original BCAT to create the BCAT-SF. To ensure content validity, the six items selected represented the cognitive domains of contextual memory, executive functioning, and attention. Psychometric analyses confirmed strong evidence of reliability, construct validity, and predictive validity. The BCAT-SF differentiated between mild cognitive impairment and dementia with a sensitivity of 0.90, a specificity of 0.81, and an area under the receiver operating characteristic curve of 0.93. Furthermore, the BCAT-SF predicted instrumental and basic activities of daily living. The BCAT-SF can be administered in three to four minutes, is easily administered (by provider or technician), and is cost-effective. In addition, preliminary evidence finds the BCAT-SF to be psychometrically robust.

The Brief Cognitive Assessment Tool (BCAT): a new test emphasizing contextual memory, executive functions, attentional capacity, and the prediction of instrumental activities of daily living.

The Brief Cognitive Assessment Tool (BCAT) is a new screening measure for cognitive dysfunction that emphasizes contextual memory and executive control functions. A total of 104 older adults referred for neuropsychological evaluation were recruited from assisted-living facilities. Psychometric analyses confirmed strong evidence for reliability, construct validity, and predictive validity. The BCAT's utility for identifying dementia versus mild cognitive impairment was excellent, with a sensitivity of .99, a specificity of .77, and an area under the receiver-operating characteristic (ROC) curve of .95. Executive control, contextual memory, and attentional capacity items were the best predictors of diagnostic category and of instrumental activities of daily living.