Caregiver-Recipient Closeness and Symptom Progression in Alzheimer Disease. The Cache County Dementia Progression Study
Open accessAbstract
Applying Rusbult's investment model of dyadic relationships, we examined the effect of caregiver-care recipient relationship closeness (RC) on cognitive and functional decline in Alzheimer's disease. After diagnosis, 167 participants completed up to six visits, observed over an average of 20 months. Participants were 64% women, had a mean age of 86 years, and mean dementia duration of 4 years. Caregiver-rated closeness was measured using a six-item scale. In mixed models adjusted for dementia severity, dyads with higher levels of closeness (p < .05) and with spouse caregivers (p = .01) had slower cognitive decline. Effect of higher RC on functional decline was greater with spouse caregivers (p = .007). These findings of attenuated Alzheimer's dementia (AD) decline with closer relationships, particularly with spouse caregivers, are consistent with investment theory. Future interventions designed to enhance the caregiving dyadic relationship may help slow decline in AD.
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The MMSE has been criticized for significant floor effects when studying persons with severe dementia.
“Some measures (e.g., MMSE) have been criticized for differential performance in classifying the cognitive status of individuals from different ages and educational backgrounds, and for significant floor effects when studying persons with severe dementia (reviewed in (43)).”
From Progression of Cognitive, Functional, and Neuropsychiatric Symptom Domains in a Population Cohort With Alzheimer Dementia: The Cache County Dementia Progression Study (2011) · cites this paper as [43]
The Outcomes section (page unavailable) describes administering the MMSE to participants with advanced dementia and occasionally discontinuing it because of poor comprehension. It does not discuss floor effects. Searches for floor effects and the MMSE’s ability to detect further decline in advanced dementia found no passage supporting the attributed criticism. (LLM, conf=0.72)
Experimental — accuracy not yet measuredThe MMSE has been criticized for differential performance in classifying cognitive status of individuals from different ages and educational backgrounds.
“Some measures (e.g., MMSE) have been criticized for differential performance in classifying the cognitive status of individuals from different ages and educational backgrounds, and for significant floor effects when studying persons with severe dementia (reviewed in (43)).”
From Progression of Cognitive, Functional, and Neuropsychiatric Symptom Domains in a Population Cohort With Alzheimer Dementia: The Cache County Dementia Progression Study (2011) · cites this paper as [43]
The Outcomes section (page not provided) describes the MMSE as a cognitive screening test, while the Analysis and Cognitive Trajectory sections examine age and education as predictors of MMSE scores or decline. None of these passages criticizes the MMSE for classifying cognitive status differently across age or educational groups. Searches for differential classification, age and education bias, and MMSE limitations found no such statement in our copy. (LLM, conf=0.77)
Experimental — accuracy not yet measured
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- Authors
- Norton, M. C., Piercy, K. W., Rabins, P. V., Green, R. C., Breitner, J. C. S., Ostbye, T., Corcoran, C., Welsh-Bohmer, K. A., Lyketsos, C. G., & Tschanz, J. T.
- Affiliations
- Utah State University (US)
- Johns Hopkins University (US)
- Boston University (US)
- University of Washington (US)
- Duke Medical Center (US)
- Venue
- The Journals of Gerontology Series B: Psychological Sciences and Social Sciences
- Publisher
- Oxford University Press (OUP)
- Published
- 2009-06-29
- Volume
- 64B
- Issue
- 5
- Pages
- 560-568
- ISSN
- 1079-5014 (ISSN-L)
- 1758-5368
- PMC
- PMC2728091
- OpenAlex
- W2160616246
- Cited by
- 139
- References
- 54
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 8 · 2023: 4 · 2022: 8 · 2021: 14 · 2020: 9 · 2019: 10 · 2018: 10 · 2017: 8 · 2016: 8 · 2015: 8 · 2014: 7 · 2013: 6 · 2012: 11
- FWCI
- 6.18
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journals of Gerontology Series B (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Digital Commons - USU (Utah State University) (submittedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- National Institute on Aging (R01AG031272, AG027841, AG-011380, AG031272, AG018712, AG021136, R01AG011380, R01AG021136, R01AG018712, K24AG027841)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Social Sciences › Psychology › Social Psychology › Attachment and Relationship Dynamics
- Health Sciences › Health Professions › Pharmacy › Nursing care and research
- Keywords
- Alzheimer's disease, cognitive decline, functional decline, spousal caregivers, dyads, dementia progression
- MeSH terms
- Alzheimer Disease, Family Relations, Female, Follow-Up Studies, Humans, Male, Marriage, Mental Status Schedule, Neuropsychological Tests, Parent-Child Relations, Cohort Studies, Caregivers, Cost of Illness, Disease Progression, Spouses
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