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The Journals of Gerontology Series B: Psychological Sciences and Social Sciences Advance Access originally published online on June 29, 2009
The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 2009 64B(5):560-568; doi:10.1093/geronb/gbp052
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© The Author 2009. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

Caregiver–Recipient Closeness and Symptom Progression in Alzheimer Disease. The Cache County Dementia Progression Study

Maria C. Norton1,2,3, Kathleen W. Piercy1,3, Peter V. Rabins4, Robert C. Green5,6,7, John C. S. Breitner8,9, Truls Østbye10, Christopher Corcoran3,11, Kathleen A. Welsh-Bohmer12,13, Constantine G. Lyketsos4,* and JoAnn T. Tschanz2,3,*

1 Department of Family, Consumer and Human Development
2 Department of Psychology
3 Center for Epidemiologic Studies, Utah State University, Logan
4 Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
5 Department of Neurology
6 Department of Medicine (Genetics), Boston University School of Medicine, Massachusetts
7 Department of Epidemiology, Boston University School of Public Health, Massachusetts
8 VA Puget Sound Health Care System, Seattle, Washington
9 Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
10 Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina
11 Department of Mathematics and Statistics, Utah State University, Logan
12 Department of Psychiatry and Behavioral Sciences
13 Bryan Alzheimer's Disease Research Center, Duke University Medical Center, Durham, North Carolina

Address correspondence to Maria C. Norton, PhD, Department of Family, Consumer and Human Development, Utah State University, 2905 Old Main Hill, Logan, UT 84322-2905. Email: maria.norton{at}usu.edu


  Abstract

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.

Key Words: Alzheimer's disease • Caregiving • Interpersonal relations

Received October 27, 2008; Accepted May 25, 2009

* These authors share equal role as senior author.

Decision Editor: Rosemary Blieszner, PhD


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