BACKGROUND AND OBJECTIVES:Care recipients with neurodegenerative disease can have socioemotional impairments that are challenging for their caregivers. We examine the concurrent and incremental validity of a novel informant-rated measure of care recipient functioning, the Caregiver Assessment of Socioemotional Functioning (CASEF), by examining links with clinician-rated behavioral problems, neuropsychiatric symptoms, and disease severity, as well as caregivers' reported burden and relationship quality. We also examine test-retest reliability of the CASEF. RESEARCH DESIGN AND METHODS:Informal caregivers (N = 177) of individuals with neurodegenerative disease reported on their care recipients' socioemotional functioning and completed structured interviews with clinicians to assess care recipients' disease severity and neuropsychiatric symptoms. Care recipients' behavioral symptoms were evaluated with clinician rating scales. Another sample of caregivers (N = 61) repeated the CASEF 4-6 months following an initial administration. RESULTS:CASEF subscales evidenced concurrent validity with other measures of care recipients' socioemotional functioning, disease severity, neuropsychiatric symptoms, and behavioral symptoms. CASEF subscales also evidenced incremental validity by accounting for significant additional variance in caregiver burden and relationship quality after accounting for care recipients' neuropsychiatric and behavioral symptoms. Finally, CASEF subscales demonstrated adequate to excellent test-retest reliability. DISCUSSION AND IMPLICATIONS:Findings highlight the validity and reliability of the CASEF. Coupled with findings from Part 1 of this series (which established CASEF's construct validity), these findings support using the CASEF in clinical and research settings to assess changes in care recipient socioemotional functioning over time and to examine links between care recipient socioemotional changes and caregiver burden, health, and well-being.

BACKGROUND AND OBJECTIVES:Neurodegenerative diseases cause socioemotional changes that are commonly measured using laboratory-based assessments. However, these assessments can be labor-, cost-, and time-intensive. We aim to establish the psychometric properties of a novel informant-rated measure, the Caregiver Assessment of Socioemotional Functioning (CASEF). RESEARCH DESIGN AND METHODS:Using 3 independent samples including 366 informal caregivers and their 366 care recipients with a variety of neurodegenerative diseases and 240 neurotypical individuals, we conducted exploratory and confirmatory factor analyses to establish the structural validity of the CASEF. Additionally, to establish convergent validity, we compared caregiver reports of socioemotional functioning to care recipients' objective performance on a variety of laboratory measures of socioemotional functioning. RESULTS:The CASEF captured multiple aspects of care recipients' socioemotional functioning, including the ability to (a) generate negative emotional responses (negative emotional reactivity), (b) generate positive emotional responses (positive emotional reactivity), (c) recognize others' emotions (emotion recognition), and (d) control emotional responses (emotion regulation). Each factor was associated with a corresponding laboratory-based measure, except for emotion regulation, which instead corresponded to a clinician-rated measure of care recipient disinhibition. DISCUSSION AND IMPLICATIONS:Findings suggest the CASEF is a psychometrically sound informant-report measure of socioemotional functioning in people living with neurodegenerative diseases and may be a valuable tool for identifying specific socioemotional impairments in the context of neurodegenerative disease.

Apathy, a common neuropsychiatric symptom of neurodegenerative disorders, involves a lack of motivation and reduced interest in positive activities, along with diminished concern for others. Deficits in basic aspects of emotional functioning including difficulties recognizing emotions (emotion recognition) and generating positive or negative emotions (positive and negative emotional reactivity) may underpin neuropsychiatric symptom clusters like apathy. Neural systems (i.e., anterior cingulate cortex, putamen, ventral striatum) that support emotional functioning may also be implicated in apathy. This study examined the behavioral and neural correlates of apathy in dementia. The study included 434 care-recipients with a variety of neurodegenerative disorders (n = 275), individuals at risk of transitioning to a neurodegenerative disease (n = 123), and healthy controls (n = 36). Care-recipients underwent neuropsychological testing, neuroimaging, and clinical interviews to obtain a diagnosis. Caregivers reported on their care recipient’s emotional functioning using a well-validated questionnaire and apathy was assessed using a clinical interview. We first tested whether the three aspects of emotional functioning (emotion recognition, positive emotional reactivity, and negative emotional reactivity) were associated with apathy using a linear regression. Then we examined the neural correlates of apathy with voxel-based morphometry. Greater apathy correlated with diminished positive emotional reactivity and emotion recognition, even after accounting for a number of covariates (i.e., care recipient age, gender, education, race, cognitive impairment, and diagnosis). Apathy was not significantly associated with negative emotional reactivity. At the neural level, increased apathy was associated with reduced grey matter in the ventral striatum and anterior cingulate cortex, while reduced emotion recognition was associated with reduced grey matter in the temporal cortex (Fusiform Gyrus & Temporal Pole). We did not find any significant association between grey matter volume and positive reactivity. Findings suggest that the abilities to recognize emotions and generate positive emotions are linked to apathy symptoms. Apathy in dementia may be associated with deficient activation in brain regions involved in reward and salience detection, whereas deficits in emotion recognition were linked to regions involved in face perception and social cognition. Further disentangling the associations between emotional functioning and neuropsychiatric symptoms may improve differential diagnosis and promote more targeted interventions.

Abstract Understanding other people’s emotions accurately (i.e., empathic accuracy) is thought to be critical for building and maintaining social connections. Past research suggests empathic skills change with age, but few studies examine age differences in empathic accuracy within the context of close relationships. We examined whether empathic accuracy is higher among middle-aged couples (ages 40-50) compared to older couples (ages 60-70) using a sample of 154 heterosexual long-term marriages. Husbands and wives visited the laboratory and engaged in a 15-minute conversation on a topic of disagreement in their marriage. Conversations were video-recorded. Husbands and wives watched a video playback of their conversation twice, each time continuously rating either their own or their spouse’s emotional valence during the conversation using a rating dial that ranged from “very negative” to “very positive”. These continuous valence ratings were used to compute each spouse’s empathic accuracy as the strength of the correlation between their ratings of their spouse’s emotions and their spouse’s own self- ratings. Results revealed that age was not associated with husbands’ empathic accuracy. In contrast, older wives had greater empathic accuracy compared to middle-aged wives (Mdiff =.19, p =.028). However, older adults had been married longer, and length of marriage also predicted women’s empathic accuracy. Findings suggest that older women are better able to track the changing valence of their husbands’ emotions, perhaps because they have more practice.

Empathic accuracy, the ability to accurately understand other people’s emotions, is a complex social cognitive skill that is often impaired in schizophrenia and this impairment is associated with poor functional outcomes. Intranasally administered oxytocin, a neuropeptide implicated in social behavior, is thought to improve empathic accuracy for individuals with schizophrenia. However, early experiences related to caregiving may shape the oxytocinergic system and influence individual responses to oxytocin administration. Using a cross-over, double-blind, placebo-controlled design coupled with fMRI, the current study investigated whether administration of oxytocin improves empathic accuracy in schizophrenia compared to a matched placebo, and the moderating role of early maternal care. Results revealed that, compared to controls, individuals with schizophrenia had lower empathic accuracy and recruited a sparser pattern of neural activation to achieve empathic accuracy. Oxytocin administration was not associated with improved empathic accuracy for either group. However, in both groups, individuals reporting higher maternal care demonstrated the greatest improvements in empathic accuracy with oxytocin administration, accompanied by decreased activity in the right dorsolateral prefrontal cortex, a region implicated in selective attention to socioemotional stimuli. Findings highlight the importance of examining individual differences in responses to oxytocin administration and suggest that early social experiences influence later responses to oxytocin administration.

The label “deaths of despair” for rising US mortality related to drugs/alcohol/suicide seems to implicate emotional distress as the cause. However, a Durkheimian approach would argue that underlying structural factors shape individuals’ behavior and emotions. Despite a growing literature on deaths of despair, no study has directly compared the effects of distress and structural factors on deaths of despair versus other causes of mortality. Using data from the Midlife in the United States study with approximately 26 years of mortality follow-up, we evaluated whether psychological or economic distress, employment status, and social integration were more strongly associated with drug/alcohol/suicide mortality than with other causes. Cox hazard models, adjusted for potential confounders, showed little evidence that psychological or economic distress were more strongly associated with mortality related to drugs/alcohol/suicide than mortality from other causes. While distress measures were modestly, but significantly associated with these deaths, the associations were similar in magnitude for many other types of mortality. In contrast, detachment from the labor force and lower social integration were both strongly associated with drug/alcohol/suicide mortality, more than for many other types of mortality. Differences in the estimated percentage dying of despair between age 25 and 65 were larger for employment status (2.0% for individuals who were neither employed nor retired versus only 0.6% for currently employed) and for social integration (1.9% for low versus 0.7% for high integration) than for negative affect (1.2% for high versus 0.8% for no negative affect). Most of the association between distress and drug/alcohol/suicide mortality appeared to result from confounding with structural factors and with pre-existing health conditions that may influence both the perception of distress and mortality risk. While deaths of despair result from self-destructive behavior, our results suggest that structural factors may be more important determinants than subjective distress.

Caring for a person with dementia (PWD) can produce declines in caregivers’ emotional well-being and physical functioning, which could result from disruptions in the emotional linkage between PWDs and caregivers. We examined the effects of interpersonal linkage in emotional behaviors on emotional well-being and physical functioning in caregivers and control partners. Forty-five PWD–caregiver dyads and 12 control dyads had a 10-min unrehearsed conflict conversation in the laboratory. We quantified positive and negative emotional linkage as the covariation between objectively coded positive and negative emotional behaviors during the conversation. Caregivers and one partner in the control dyads completed questionnaires concerning their emotional well-being and physical functioning. We found that lower positive emotional linkage was associated with lower emotional well-being in caregivers and control partners. We did not find similar effects with negative emotional linkage or for physical functioning. We offer possible explanations for these findings and implications for assessing caregiver risk.

Abstract Neurodegenerative diseases lead to deficits in cognitive functioning that could disrupt the ability to perceive others’ emotions. We examined whether cognitive deficits in semantic knowledge and executive function relate to two aspects of emotion perception. Individuals with frontotemporal dementia and healthy controls (N = 110; 33 behavioral variant, 23 non-fluent variant, 30 semantic variant, and 24 healthy controls) completed cognitive tests of semantic word knowledge (Peabody Picture Vocabulary Test and Boston Naming Test) and executive function (Digit Span Backwards, Stroop, Design Fluency, and Trail-Making). To assess different facets of emotion perception, participants completed an emotion labeling task that measured the ability to identify specific emotions (sad, happy) experienced by characters in films and an emotion tracking task that measured the ability to continuously track the emotional valence of a character in a film using a rating dial. Regression analyses revealed that semantic word knowledge was associated with emotion labeling but not emotion tracking, even after accounting for relevant covariates (diagnosis, age, sex, global cognition, and dementia severity). Executive function was associated with both emotion labeling and emotion tracking, even when accounting for covariates. Steiger’s Z test revealed that executive function was more strongly associated with emotion valence tracking than with emotion category labeling. Findings reveal how distinct neurocognitive abilities are linked with unique facets of emotion perception. Semantic word knowledge may subserve the ability to distinguish between specific emotion categories and executive function may be more important when continuously updating one’s unfolding emotions than making a single emotional judgment.

Objectives Dementia caregivers (CGs) are at heightened risk for developing problems with anxiety and depression. Much attention has been directed toward developing and deploying interventions designed to protect CG health, but few have been supported by rigorous empirical evidence. Technology-based interventions that are effective, scalable, and do not add greatly to the CG burden are of particular interest.Methods We conducted a nine-month randomized controlled trial in 63 homes evaluating People Power Caregiver (PPCg), a system of sensors in the home connected to cloud-based software that alerts CGs about worrisome deviations from normal patterns (e.g., falls, wandering).Results CGs in the active condition had significantly less anxiety than those in the control condition at the six-month assessment. Greater anxiety reduction in the active condition at the six-month assessment was associated with greater interaction with PPCg via SMS text messages. There were no differences in anxiety at the three-month or nine-month assessments or in depression at any assessment.Conclusions PPCg shows promise for reducing anxiety associated with caring for a =person with dementia.Clinical implications Technology-based interventions can help reduce CG anxiety, a major adverse consequence of caregiving that may be difficult to treat due to other demands on caregiver time and energy.

INTRODUCTION:Providing care for a loved one with dementia can engender intense emotions that contribute to symptoms of anxiety and depression. Caregivers often attempt to regulate their emotions using strategies like cognitive reappraisal (CR; changing how they think about the situation) or expressive suppression (ES; hiding their emotions). However, men and women caregivers may differ in their use of these strategies. The current study examines gender differences in reported CR and ES usage and their associations with depression and anxiety in dementia caregivers.METHODS:We combined data from three independent studies of informal dementia caregivers (total N = 460) who reported on their use of CR, ES, and symptoms of anxiety and depression.RESULTS:Women caregivers reported greater use of CR and less use of ES compared to men. Gender moderated the association between CR and depression, such that greater use of CR in women was associated with fewer depressive symptoms, but not for men. Gender did not significantly moderate the association between ES and depression, or between either emotion regulation strategy and anxiety.CONCLUSION:Findings of a unique relationship between greater CR use and less depression among women CGs, although correlational, suggest that utilizing CR may be particularly helpful for reducing depression in women caregivers. These results underscore the need for further research to determine how best to support the mental well-being of dementia caregivers.

Abstract Persons with neurodegenerative diseases (PWDs) often develop profound declines in the ability to recognize emotions in others that lead to diminished social connectedness with their loved ones. Physiological linkage, which refers to the degree that people’s physiological responses change in coordinated ways, can serve as a proxy measure for social connectedness. Physiological linkage has been found to be diminished during interactions between PWDs (i.e., care recipients) and their family caregivers. However, the association between diminished physiological linkage and PWDs’ lower emotion recognition has not been determined. In a sample of 28 PWD-family caregiver dyads, we quantified physiological linkage as the positive (“in-phase”) correlations between PWD’s and caregiver’s somatic activity. Somatic activity was measured remotely via actigraphy using wristwatches worn by both partners in their homes during waking hours for 7 days. PWDs’ emotion recognition was quantified as the ability to recognize positive and negative emotions of their caregivers accurately during a 10-minute conflict conversation in our laboratory prior to the 7-day home assessment. Lower emotion recognition by PWDs of their caregivers’ negative emotions (β = .49, p = .01), but not positive emotions (β = .12, p = .52) in the laboratory assessment was associated with lower physiological linkage between PWDs and caregivers in their home. Establishing a relationship between PWDs’ deficits in emotion recognition and diminished physiological linkage during conversations with their caregivers provides a basis for understanding problems in establishing social connections that are often observed in PWDs.

Abstract Emotional impairments are a common symptom of neurodegenerative disorders that can be devastating for persons with the dementia (PWDs) and family members who provide care (i.e., caregivers). Emotional functioning can be well characterized and quantified using laboratory assessments of behavioral, physiological, and self-reported responses to emotional stimuli. However, continuous declines in functioning make it especially difficult for PWDs and caregivers to visit a research laboratory repeatedly over time. In order to understand changes in emotional functioning across time and their impact on PWDs and caregivers longitudinally, there is a need for technology to support remote assessments of emotional functioning. We developed a portable version of laboratory assessments—Laboratory in a Suitcase Assessment (LISA)—to collect data from PWDs and their caregivers remotely in their homes. In a shippable suitcase, LISA provides the necessary equipment for: (a) presenting emotional stimuli via laptop screen and headphones; (b) obtaining audio and video recordings of participants’ behavior; (c) obtaining continuous ratings of emotional experience via a rating dial; (d) measuring cardiovascular, electrodermal, and somatic responses from PWDs and caregivers via wearable devices; (e) synchronizing behavior and physiology; and (f) maintaining two-way communication with participants via Zoom. We present high quality physiological, behavioral, and self-report data collected using LISA with 17 PWD-caregiver dyads. Data collected with LISA are comparable to data collected in the laboratory, indicating that LISA could enable researchers to continue data collection further into the course of disease when travel to in-person laboratory sessions would no longer be feasible.

Positivity resonance refers to moments of connection characterized by shared positive affect, caring nonverbal synchrony, and biological synchrony. We measured positivity resonance as a latent factor indicated by five dyad-level measures drawn from marital conflict interactions. The latent factor of positivity resonance had excellent fit, and it predicted less steep declines in spouses' health over 13 years.

Empathic accuracy, the ability to accurately understand other people’s emotions, is typically viewed as beneficial for mental health. However, empathic accuracy may be problematic when a close relational partner is depressed because it promotes shared depression. Across two studies, we measured empathic accuracy using laboratory tasks that capture the ability to rate other people’s emotional valence accurately over time: first in a sample of 156 neurotypical married couples (Study 1; total N = 312), and then in a sample of 102 informal caregivers of individuals with dementia (Study 2). Across both studies, the association between empathic accuracy and depressive symptoms varied as a function of a partner’s level of depressive symptoms. Greater empathic accuracy was associated with (a) fewer depressive symptoms when a partner lacked depressive symptoms, but (b) more depressive symptoms when a partner had high levels of depressive symptoms. The ability to accurately detect changes in other people’s emotional valence may underpin shared depressive symptoms in dyads.

Abstract Dementia caregivers can experience negative affect when interacting with their care recipients. However, few studies have examined the specific factors that predict caregiver negative affect in this dyadic context. We hypothesized that deficits in care recipients’ emotional functioning would be associated with increased intensity of caregivers’ negative affect during interactions with their care recipient. Caregivers (Nf100) reported on two aspects of their care recipients’ emotional functioning: (1) emotion recognition (the ability to recognize other people’s emotions), and (2) negative emotional reactivity (the ability to generate negative emotional responses). Dyads then visited the laboratory and engaged in a 10-minute conversation about an area of conflict in their relationship. Caregivers then watched recordings of their conversation while rating the valence and intensity of their experienced affect using a rating dial. We used these ratings to quantify changes in caregivers’ emotional valence across the course of the conversation. Caregivers of care recipients with greater deficits in emotion recognition demonstrated greater increases in negative affect across the conversation. In contrast, care recipients’ negative emotional reactivity was not related to changes in the valence of caregivers’ affect across the conversation. Findings remained significant even after accounting for caregiver baseline valence ratings, biological sex, and age, as well as the care recipients’ diagnosis and level of cognitive impairment. Results reveal the important role that care recipients’ deficits in emotion recognition play in caregivers’ emotional lives. Caregivers’ negative affect may be more likely to increase when their care recipient has deficits in emotion recognition.

AIM:The current study examined whether visual attention to emotional facial expressions is lower in individuals with frontotemporal dementia (FTD) compared to healthy controls, and whether visual attention to emotional facial expressions is associated with the ability to perceive others' emotional valence accurately. METHODS:Participants with FTD (n = 17) and healthy controls (n = 23) passively viewed pairs of emotional and neutral faces while their visual attention was measured using eye-tracking. A subsample of participants (n = 28) also completed an emotional valence perception task. RESULTS:Individuals with FTD spent less time looking at emotional faces than healthy controls. However, there was no difference in the amount of time individuals with FTD spent looking at neutral faces as compared to healthy controls. In the subsample, less time spent looking at emotional faces (but not neutral faces) was associated with a less accurate perception of others' emotional valence. CONCLUSION:Individuals with FTD displayed diminished visual attention to emotional facial expressions compared to healthy controls. Reduced attention towards emotional faces was associated with poorer emotional valence perception. Findings point toward diminished visual attention as potentially relevant for understanding oft-observed impairments in socioemotional functioning in FTD.

The Positivity Resonance Theory of coexperienced positive affect describes moments of interpersonal connection characterized by shared positive affect, caring nonverbal synchrony, and biological synchrony. The construct validity of positivity resonance and its longitudinal associations with health have not been tested. The current longitudinal study examined whether positivity resonance in conflict interactions between 154 married couples predicts health trajectories over 13 years and longevity over 30 years. We used couples' continuous ratings of affect during the interactions to capture coexperienced positive affect and continuous physiological responses to capture biological synchrony between spouses. Video recordings were behaviorally coded for coexpressed positive affect, synchronous nonverbal affiliation cues (SNAC), and behavioral indicators of positivity resonance (BIPR). To evaluate construct validity, we conducted a confirmatory factor analysis to test a latent factor of positivity resonance encompassing coexperienced positive affect, coexpressed positive affect, physiological linkage of interbeat heart intervals, SNAC, and BIPR. The model showed excellent fit. To evaluate associations with health and longevity, we used dyadic latent growth curve modeling and Cox proportional hazards modeling, respectively, and found that greater latent positivity resonance predicted less steep declines in health and increased longevity. Associations were robust when accounting for initial health symptoms, sociodemographic characteristics, health-related behaviors, and individually experienced positive affect. We repeated health and longevity analyses, replacing latent positivity resonance with BIPR, and found consistent results. Findings validate positivity resonance as a multimodal construct, support the utility of the BIPR measure, and provide initial evidence for the characterization of positivity resonance as a positive health behavior. (PsycInfo Database Record (c) 2022 APA, all rights reserved).