This study examines the relationship of personal mastery and perceived emotional support to depressive symptoms for spousal dementia caregivers (CGs) and noncaregiver (NCG) spouses. Although it is well known that caring for a spouse with dementia is stressful and that personal mastery and emotional support may reduce stress, the authors hypothesize that these resources are more important for reducing stress in the difficult situation of dementia care than in everyday life for older persons. In bivariate comparisons, CG levels of perceived support and mastery were, lower and depression was higher than for NCGs. Consistent with prior research, a hierarchical multiple regression with combined data shows that CG status was a significant predictor of depressive symptoms. A significant interaction of CG status with personal mastery indicates greater impact of mastery on depression among CGs than among NCGs. This unique finding strongly supports interventions focusing on enhancement of mastery among spousal CGs.

Objectives: To study the associations between dementia/mild cognitive impairment (MCI) and cognitive performance and activity levels in youth.Design: Retrospective cohort study.Setting: Research volunteers living throughout the United States.Participants: A total of 396 persons (mean age 75) who were graduates of the same high school in the mid‐1940s.Measurements: Adolescent intelligence quotient (IQ) scores were gathered from archived student records, and activity levels were determined from yearbooks. A two‐stage telephone screening procedure (Modified Telephone Interview for Cognitive Status or Informant Questionnaire on Cognitive Decline in the Elderly followed by Dementia Questionnaire) was used to determine adult cognitive status. Data were analyzed using logistic regression to model the risk of cognitive impairment (dementia/MCI) versus no cognitive impairment as a function of IQ and activity level, adjusting for sex and education.Results: High adolescent IQ and greater activity level were each independently associated with a lower risk for dementia/MCI (odds ratio (OR) for a 1‐standard deviation increase in IQ=0.51, 95% confidence interval (CI)=0.32–0.79; OR for a unit increase in activity=0.32, 95% CI=0.12–0.84). No association was found between sex or education and adult cognitive status in this model.Conclusion: High IQ and greater activity levels in youth reduce the risk for cognitive impairments in aging. The mechanism(s) underlying these associations are unknown, but intelligence may be a marker for cognitive/neurological “reserve,” and involvement in activities may contribute to “reserve.” Early neuropathology and ascertainment bias are also possible explanations for the observed associations.

OBJECTIVE:To investigate the association between Alzheimer disease (AD) and worker functions and traits associated with occupations.BACKGROUND:Studies have reported that occupational attainment is related to AD. However, most have not identified specific worker functions and traits (i.e., occupational demands) of occupations that may explain the association, nor have they accounted for changing occupational demands over time.METHODS:Within- and between-group differences in mental, motor, physical, and social occupational demands of 122 AD cases and 235 control subjects were compared across four decades of life (20s, 30s, 40s, and 50s) using repeated-measures analyses of covariance adjusted for race, gender, year of birth, and education.RESULTS:Overall, mental occupational demands were significantly lower and physical occupational demands were significantly higher for cases than for control subjects. Case/control differences in mental demand scores were not found in their 20s but only in later decades. Differences in physical demands were found in all decades but their 30s. Social and motor demands did not differ between cases and control subjects. Among cases only, there were no significant occupational demand score differences across decades. In contrast, mental and social demand scores of control subjects increased in later decades, and motor demand scores declined. Like cases, physical demand scores of control subjects remained stable across the decades.CONCLUSIONS:The authors' results may indicate a relatively early influence of Alzheimer disease neuropathology on capacity to pursue mentally demanding occupations. However, results also are consistent with the notion that mentally demanding occupations have a direct influence on Alzheimer disease neuropathology.

The relationship between leisure activities and development of cognitive impairment in aging has been the subject of recent research. We examined television viewing in association with risk of developing Alzheimer’s disease (AD) in a case-control study. Given recent focus on the importance of intellectually stimulating activities as preventive measures against cognitive decline, it is important to examine the effects of less stimulating but common activities. Data are from 135 Alzheimer’s disease cases and 331 healthy controls. Demographic characteristics and life history questionnaire responses on the number of hours spent on 26 leisure activities during middle-adulthood (ages 40–59) were analyzed. Logistic regression was used to examine the effects of middle-adulthood leisure activities on case vs. control status. Results indicate that for each additional daily hour of middle-adulthood television viewing the associated risk of AD development, controlling for year of birth, gender, income, and education, increased 1.3 times. Participation in intellectually stimulating activities and social activities reduced the associated risk of developing AD. Findings are consistent with the view that participation in non-intellectually stimulating activities is associated with increased risk of developing AD, and suggest television viewing may be a marker of reduced participation in intellectually stimulating activities.

In a case control study of genetic and lifestyle risk factors for Alzheimer's disease (AD), we obtained recalled food consumption frequencies translated to nutrients and averaged over 2 age periods of adult life, 20 to 39 and 40 to 59 years. The proportion of controls with the apolipoprotein E ϵ4 (APOE ϵ4) genotype was significantly higher in the lowest tertile of fat consumption (36.3% of energy) compared with controls with ϵ4 in the highest tertile of fat intake (44.6% of energy). Healthy older persons with the ϵ4 allele who survived to be included in this study may be protected with lower dietary fat intake and other healthy behaviors. Diet-genotype interactions may have important influences on disorders of later life. Copyright 2003, Elsevier Science (USA). All rights reserved.

Several studies have noted that spouse caregivers'negative affectivity, or neuroticism, is associated with the use of emotion-focused coping strategies. This association may be artificially inflated, however, due to the common mode of assessment used in these studies or to the reactive relationship between negative affectivity and coping. To address this issue, this study examined the relationship between self-reporting and informant reporting of negative affectivity and selfreported coping. Informants, adult children (N = 39) of caregivers, completed the NEO–Five Factor Index, in which they described their caregiver parent prior to the onset of dementia in their other parent. Caregivers completed measures of current coping and distress. Only emotion-focused coping showed a tendency to be more highly correlated with self-reported than with informant-reported negative affectivity. Correlations between self-reports of negative affectivity and use of emotion-focused coping may reflect a reciprocal interaction between these two variables and therefore may overestimate their association.

Surrogates must be used as respondents in case control studies in which cases are cognitively impaired. A potential for misclassification exists when surrogate reports are used in dietary studies ( (1) Nelson L.M. Longstreth W.T.J. Koepsell T.D. vanBelle G. Proxy respondents in epidemiologic research. Epidemiol Rev. 1990; 12: 71-86 Google Scholar , (2) Samet J.M. Surrogate measures of dietary intake. Am J Clin Nutr. 1989; 50: 1139-1144 Google Scholar , (3) Samet J.M. Alberg A.J. Surrogate sources of dietary information. in: Willett W. Oxford University Press, ed. Nutritional Epidemiology. New York1998 Google Scholar ). Validation studies have used self-reports of healthy subjects and compared them with their surrogates’ reports. These studies indicate that misclassification with use of surrogate reports may not result in bias or changes in odds ratios in epidemiological studies ( (4) Nelson L.M. Longstreth W.T.J. Koepsell T.D. Checkoway H. vanBelle G. Completeness and accuracy of interview data from proxy respondents Demographic, medical, and life-style factors. Epidemiology. 1994; 5: 204-217 Google Scholar , (5) Herrmann N. Retrospective information from questionnaires. I. Comparability of primary respondents and their next-of-kin. Am J Epidemiol. 1985; 121: 937-947 Google Scholar , (6) Samet J.M. Skipper B.J. Humble C.G. Pathak D.R. Lung cancer risk and vitamin A consumption in New Mexico. Am Rev Respir Dis. 1985; 131: 198-202 Google Scholar ). Other studies that compared control-surrogate responses using the κ statistic have shown good agreement but did not address the issue of misclassification ( (6) Samet J.M. Skipper B.J. Humble C.G. Pathak D.R. Lung cancer risk and vitamin A consumption in New Mexico. Am Rev Respir Dis. 1985; 131: 198-202 Google Scholar , (7) Moore M.C. Moore E.M. Beasley C.D.H. Hankins G.J. Judlin B.C. Dietary-atherosclerosis study on deceased persons Methodology. J Am Diet Assoc. 1970; 56: 13-28 Google Scholar , (8) Kolonel L.N. Hirohata T. Nomura A.M.Y. Adequacy of survey data collected from substitute respondents. Am J Epidemiol. 1977; 106: 476-484 Google Scholar , (9) Marshall J. Priore R. Haughey B. Rzepka T. Graham S. Spouse-subject interviews and the reliability of diet studies. Am J Epidemiol. 1980; 112: 675-683 Google Scholar , (10) Humble C.G. Samet J.M. Skipper B.E. Comparison of self- and surrogate-reported dietary information. Am J Epidemiol. 1984; 119: 86-98 Google Scholar , (11) Lerchen M.L. Samet J.M. An assessment of the validity of questionnaire responses provided by a surviving spouse. Am J Epidemiol. 1986; 123: 481-489 Google Scholar , (12) Metzner H.L. Lamphiear D.E. Thompson F.E. Oh M.S. Hawthorne V.M. Comparison of surrogate and subject reports of dietary practices, smoking and weight among married couples in the Tecumseh Diet Methodology Study. J Clin Epidemiol. 1989; 42: 367-375 Google Scholar , (13) Heyman A. Wilkinson W.E. Stafford J.A. Helms M.J. Sigmon A.H. Weinberg T. Alzheimer's disease a study of epidemiological aspects. Ann Neurol. 1984; 15: 335-341 Google Scholar ). Most studies involving subjects who are not able to respond themselves typically use surrogates for both cases and controls. Few studies have been done to determine the possible direction of bias when data are obtained from surrogates and from controls themselves ( (3) Samet J.M. Alberg A.J. Surrogate sources of dietary information. in: Willett W. Oxford University Press, ed. Nutritional Epidemiology. New York1998 Google Scholar ).

OBJECTIVE:To examine the presence and extent of bias introduced by using surrogate respondents for healthy controls in a case-control study of Alzheimer's disease (AD). DESIGN:Comparative study of matched responses to questionnaire ascertaining lifestyle issues. SETTING:University Hospitals/Case Western Reserve University Alzheimer Center. PARTICIPANTS:Controls (n = 50) were identified through the Research Registry. Surrogates (n = 50) were their healthy relatives or friends. MEASUREMENTS:Answers in the areas of demographic and occupational history, smoking habits, medical history, dietary intake, and leisure and work activities were recorded. The analysis was based on methods for paired data. Continuous variables were analyzed, focusing on paired differences between self and surrogate responses. RESULTS:For occupations and exposures, over 80% of the surrogates agreed with the subjects on over 80% of the questions. On smoking history, over 90% of the surrogates agreed with the subjects on over 70% of the questions. On leisure and work activities, over 70% of the surrogates agreed with the subjects on over 50% of the questions. There was less agreement regarding medical history. For continuous variables, most paired t-tests of zero mean difference between self and surrogate responses resulted in nonrejection of this hypothesis. Computed mean differences were not always positive or always negative. CONCLUSION:We did not find systematic under- or overreporting by the surrogates of the controls. Therefore, if there are biases in the responses of surrogates of the AD cases in our case-control study, they would not be canceled out by using surrogates for the controls.

The purpose of this study was to examine the effects, over time, of depressive symptoms in persons with Alzheimer's disease on depression in their family caregivers. In a sample of 353 patients and caregivers, multilevel longitudinal analysis was used to accommodate an observational design in which the number of observation points and the intervals between points varied across caregivers. The rate of change (increase) in caregiver depression was predicted by the rate of change (increase) in patient depressive symptoms and by increase in patient dependency in instrumental activities of daily living (ADLs). Acceleration of the increase in caregiver depression was predicted by acceleration in patient dependency in instrumental and basic ADLs but not by acceleration in patient depressive symptoms. These findings indicate the importance of measuring the rate and acceleration of change in patient characteristics in order to understand caregiver depression. They also support early interventions for caregivers.

The development of Alzheimer's disease (AD) later in life may be reflective of environmental factors operating over the course of a lifetime. Educational and occupational attainments have been found to be protective against the development of the disease but participation in activities has received little attention. In a case-control study, we collected questionnaire data about 26 nonoccupational activities from ages 20 to 60. Participants included 193 people with probable or possible AD and 358 healthy control-group members. Activity patterns for intellectual, passive, and physical activities were classified by using an adaptation of a published scale in terms of “diversity” (total number of activities), “intensity” (hours per month), and “percentage intensity” (percentage of total activity hours devoted to each activity category). The control group was more active during midlife than the case group was for all three activity categories, even after controlling for age, gender, income adequacy, and education. The odds ratio for AD in those performing less than the mean value of activities was 3.85 (95% confidence interval: 2.65–5.58, P < 0.001). The increase in time devoted to intellectual activities from early adulthood (20–39) to middle adulthood (40–60) was associated with a significant decrease in the probability of membership in the case group. We conclude that diversity of activities and intensity of intellectual activities were reduced in patients with AD as compared with the control group. These findings may be because inactivity is a risk factor for the disease or because inactivity is a reflection of very early subclinical effects of the disease, or both.

ever, attitudes, beliefs, and perceptions of those to whom services are targeted have been largely disregarded in studies describing or predicting service use, due in large part to researchers’ adoption of a provider-centered view of how services should be configured and marketed and how the need for such services should be determined. Recently, a number of researchers have begun calling for a refocusing on the potential explanatory power ofthese key variables (Cantor, 199 1 ; Collins, ’ Stommel, King, & Given, 1991; Kirwin & Kaye, 1991; Stone, Cafferata, & Sangl, 1987; Strain, 1991; Wister, 1992; Wolinsky & Johnson, 1991). This issue of the Journal of Applied Gerontology features a set of articles that

This study aimed to examine differences in subjective psychological well-being between husband and wife caregivers of persons with Alzheimer's disease in comparison to the psychological states of noncaregiver husbands and wives similar in age and ethnicity. The principal comparison of interest was whether differences between husband and wife caregivers were greater than those between comparison group husbands and wives. Significant interactions for six out of nine psychological measures indicate that gender-related differences between spouse caregivers were specifically associated with the caregiving role. Possible explanations for the discrepancy between husband and wife caregivers as well as practice implications are discussed.

This study investigated the relationship between two basic dimensions of social-emotional adjustment: distress and self-restraint, as identified by Weinberger and Schwartz (1990), and the use of four coping strategies by spouse caregivers of persons with Alzheimer's disease. Care givers were most frequently categorized as oversocialized (high distress, high self-restraint) and repressive (low distress, high self-restraint) according to Weinberger and Schwartz's (1990) social-emotional adjustment typology. A higher proportion of males than females were under- socialized (low distress, low self-restraint) and reactive (high distress, low self-restraint), whereas a higher proportion of females than males were oversocialized (high distress, high self-restraint). High distress caregivers were more likely to use the emotion-focused coping strategy of wishfulness, whereas low distress caregivers were more likely to use acceptance and the problem-focused strategy of instrumental coping. Although there were gender differences in distress and the use of specific coping strategies, the relationships between distress and coping strategies used held regardless of gender. Implications for caregiver intervention programs as well as directions for future research are discussed.