Pertl M M, Hannigan C, Brennan S, Robertson I H, Lawlor B A
Neuro-Enhancement for Independent Lives (NEIL) Programme,Trinity College Institute of Neuroscience (TCIN),Trinity College Dublin,Dublin 2,Ireland.
Int Psychogeriatr. 2017 Apr;29(4):615-625. doi: 10.1017/S1041610216002337. Epub 2017 Jan 9.
A substantial literature has reported that stress negatively impacts on cognitive processes. As dementia caregiving can be stressful, it has been hypothesized that the challenges of dementia care may increase caregivers' own vulnerability to cognitive decline. Prefrontal processes are thought to be most vulnerable to stress; however, few studies have examined whether greater caregiver stress predicts poorer executive dysfunction, and no previous research has considered potential moderators of this relationship. We examined (1) whether greater psychological stress mediated a relationship between caregiver stress exposure and executive functioning and (2) whether greater self-efficacy and cognitive reserve (CR) moderated this relationship.
Spousal dementia caregivers (n = 253) completed the Neuropsychiatric Inventory Questionnaire (stress exposure), the Perceived Stress Scale, the National Adult Reading Test (CR), the Fortinsky dementia-specific caregiver self-efficacy scale, and the Color Trails Test (executive functioning). Moderated mediation was tested using the PROCESS macro. Age, gender, and dementia risk factors were included as covariates.
Greater stress exposure indirectly predicted executive functioning through psychological stress. Stronger relationships between greater psychological stress and poorer executive functioning were observed among caregivers with lower CR; there was no evidence that self-efficacy moderated the relationship between stress exposure and psychological stress.
Our findings are in line with the idea that greater psychological stress in response to challenges associated with dementia care predicts poorer caregiver executive functioning, particularly among caregivers with low CR. However, these findings are cross sectional; it is also possible that poorer executive functioning contributes to greater caregiver stress.
大量文献报道，压力会对认知过程产生负面影响。由于痴呆症护理工作压力较大，因此有人推测，痴呆症护理的挑战可能会增加护理人员自身认知能力下降的易感性。前额叶功能被认为最容易受到压力的影响；然而，很少有研究探讨护理人员压力越大是否预示着执行功能障碍越严重，而且之前也没有研究考虑过这种关系的潜在调节因素。我们研究了：（1）心理压力越大是否介导了护理人员压力暴露与执行功能之间的关系；（2）自我效能感和认知储备（CR）越高是否调节了这种关系。
配偶痴呆症护理人员（n = 253）完成了神经精神科问卷（压力暴露）、感知压力量表、国家成人阅读测试（CR）、福尔廷斯基痴呆症特定护理人员自我效能量表和色线测试（执行功能）。使用PROCESS宏检验调节中介效应。将年龄、性别和痴呆症风险因素作为协变量纳入分析。
压力暴露越大通过心理压力间接预测执行功能。在CR较低的护理人员中，观察到心理压力越大与执行功能越差之间的关系越强；没有证据表明自我效能感调节了压力暴露与心理压力之间的关系。
我们的研究结果与以下观点一致，即应对痴呆症护理相关挑战时心理压力越大预示着护理人员执行功能越差，尤其是在CR较低的护理人员中。然而，这些结果是横断面研究；执行功能较差也可能导致护理人员压力更大。
