Yes / Discrepancy scores reflecting the difference between parallel ratings made by people living with dementia (PwD) in the mild-to-moderate stages and by their informants provide a way to investigate awareness of functional ability in relation to activities of daily living (ADL). Methods: Two measures of ADL (Functional Activities Questionnaire; Dependence Scale) were completed by 1,227 PwD and their informants in the IDEAL cohort study baseline assessment. Self-rated and informant-rated scores were used to calculate discrepancies, which were used as an indicator of awareness of functional ability. Smaller discrepancy scores were considered to reflect greater awareness on the part of PwD. PwD completed questionnaires on depression, personality, comorbidities, neuropsychiatric symptoms, and completed a measure of cognition. Informants provided ratings of stress. Univariable and multiple regressions were used to investigate factors related to ADL discrepancy. Results: A similar pattern of associations were found for both ADL discrepancy scores. Smaller discrepancy scores were associated with higher levels of depression, higher neuroticism, fewer neuropsychiatric symptoms, higher comorbidity, lower carer stress, and receipt of less than 1 hour of care per day from the informant. Discussion/Conclusion: There was a clear pattern of factors that were associated with greater awareness for both measures of functional ability. These factors associated with smaller discrepancy scores could be used to identify PwD who might benefit from targeted interventions to support their independence. / Economic and Social Research Council (ESRC) and the National Institute for Health and Care Research (NIHR) grant ES/L001853/2; Alzheimer’s Society as a Centre of Excellence, grant number 348, AS-PR2-16-001

Yes / Objectives: Longitudinal evidence documenting health conditions in spousal caregivers of people with dementia and whether these influence caregivers’ outcomes is scarce. This study explores type and number of health conditions over two years in caregivers of people with dementia and subgroups based on age, sex, education, hours of care, informant-rated functional ability, neuropsychiatric symptoms, cognition of the person with dementia, and length of diagnosis in the person with dementia. It also explores whether over time the number of health conditions is associated with caregivers’ stress, positive experiences of caregiving, and social networks Methods: Longitudinal data from the IDEAL (Improving the experience of Dementia and Enhancing Active Life) cohort were used. Participants comprised spousal caregivers (n = 977) of people with dementia. Self-reported health conditions using the Charlson Comorbidity Index, stress, positive experiences of caregiving, and social network were assessed over two years. Mixed effect models were used Results: On average participants had 1.5 health conditions at baseline; increasing to 2.1 conditions over two years. More health conditions were reported by caregivers who were older, had no formal education, provided 10 + hours of care per day, and/or cared for a person with more neuropsychiatric symptoms at baseline. More baseline health conditions were associated with greater stress at baseline but not with stress over time. Over two years, when caregivers’ health conditions increased, their stress increased whereas their social network diminished Discussion: Findings highlight that most caregivers have their own health problems which require management to avoid increased stress and shrinking of social networks / Economic and Social Research Council (ESRC) and the National Institute for Health and Care Research (NIHR) - grant ES/L001853/2. Alzheimer’s Society, grant number 348, AS-PR2-16-001. Sabatini was supported by an ESRC Postdoctoral fellowship (ES/X007766/1).

Although there is abundant research on the etiology of Alzheimer's disease and its impact on primary caregivers, there is relatively little research that examines the consequences of the disease for entire families, and no literature that exclusively studies the experiences of non-caregiving family members. Seeking to explore the experience of non-caregivers, this qualitative study examined how adult children of an Alzheimer's patient who were not the caregiver for their parent experienced the onset and progression of the disease. Using the guiding theoretical frameworks of phenomenology, family systems theory, and ambiguous loss, in-depth interviews were conducted with three individuals and were coded for themes. The main themes found included externalization of symptoms, belief in the Alzheimer's diagnosis, acceptance, flexibility, sibling and parental relationships, communication, planning, shared family philosophy, family of origin roles, and boundary ambiguity. Implications for clinical practice and suggestions for future research are included. / Master of Science

Caregiving research on heterosexual couples suggests that though husbands and wives generally perform the same care tasks for their spouses, wives report higher levels of mental stress, depression, and general frustration (Swinkles et al., 2017; Polenick and DePasquale 2019). Caregiving literature is unclear on why a gender difference exists regarding stress or burden when husbands and wives are largely performing the same tasks. Using gender relations theory, this study considers whether the performance of intimate tasks creates different levels of emotional stress and overall health outcomes for older, heterosexual husbands and wives caring for a spouse with Alzheimer's or related dementias. Intimate tasks (ITs) refer to tasks that likely infringe on the bodily autonomy of the care receiver and include dealing with incontinence and assisting with bathing/showering. To explore this, I conducted logistic regressions using the 2015 and 2020 "Caregiving in the U.S.'' surveys from the AARP. My results showed IT performance has a negative effect on the stress and overall health of both husbands and wives, but comparatively, there is no consistent gender difference in effect. Additional analysis found that when separating the Its, dealing with incontinence had a more negative effect on emotional stress while assisting with bathing/showering had a more negative effect on health outcomes. / Master of Science / Older spousal caregivers are responsible for completing many different tasks to properly care for their spouse. Husbands and wives typically approach completing these tasks in different ways. Husbands tend to focus strictly on completing the care tasks, while wives tend to additionally factor in their husband's emotions. Care tasks can include things such as managing medications, taking over household chores, or more intimate tasks like dealing with urinary and bowel movements or assisting with bathing. This study considers whether there is a gender difference in the effect of intimate task performance between older caregivers that care for a spouse with Alzheimer's disease or dementia. My findings show that completing these intimate tasks negatively affects husbands' and wives' emotional stress levels and overall health. When separating the two intimate tasks, dealing with urinary and bowel movements was more likely to affect levels of emotional stress. Alternatively, assisting with bathing or showering was more likely to affect overall health.

The purpose of this paper is to integrate and synthesize the literature from the fields of Horticulture Therapy (HT) and therapeutic activities for persons with dementia using the theory of environmental press Utilizing horticulture as a treatment modality, the therapist can either modify the environment or the person's competence level or both to assist persons to reach the desired Adaptation Level (AL). The AL represents an appropriate person-environment fit, and attainment of this zone is demonstrated by positive affect and adaptive behavior. At this time, research about HT for persons with dementia is limited. Applying theory to research is essential in order to clarify the appropriate outcome measures, independent variables, and research designs to the study. Therefore, research that fails to utilize theory often does little to contribute to the advancement of the field. This paper offers an environmental press perspective about HT for persons with cognitive impairment. / Master of Science

Yes / The difference between Apolipoprotein E ε4 carriers and non-carriers in response to single exercise sessions was tested. Stroop and Posner tasks were administered to young untrained women immediately after walking sessions or moderately heavy exercise. Exercise had a significantly more profound impact on the Stroop effect than on the Posner effect, suggesting selective involvement of prefrontal function. A significant genotype-by-exercise interaction indicated differences in response to exercise between ε4 carriers and non-carriers. Carriers showed facilitation triggered by exercise. The transient executive down-regulation was construed as due to exercise-dependent hypofrontality. The facilitation observed in carriers was interpreted as better management of prefrontal metabolic resources, and explained within the antagonistic pleiotropy hypothesis framework. The findings have implications for the interpretation of differences between ε4 carriers and non-carriers in the benefits triggered by long-term exercise that might depend, at least partially, on mechanisms of metabolic response to physical activity. / Partially supported by a University of Hull Faculty of Science scholarship to MDM and by funding from MIUR and FP7 VPH-DARE to AV.

The purpose of this study was to examine the relationships among the factors identified in the McCubbin ( 1993) Resiliency Model of Family Stress, Adjustment, and Adaptation (MRM) to determine the applicability of the model to caregivers for a family member with Alzheimer's Disease (AD). The MRM was developed to describe the factors that influence the family's ability to adapt to a stressful situation over time. The applicability of the MRM to family caregivers in which a family member suffers from progressive dementia, or AD, has not been evaluated. Data were collected through a mail survey sent to 300 family caregivers of persons with AD on the mailing list of a local AD service organization. An anonymous random sample of 43 family caregivers was obtained. Participants completed a demographic tool and two interval level scales developed by McCubbin and colleagues; the Family Index of Regenerativity and Adaptation General (FIRA-G) and the Family Member Well-being Index (FMWB). The instruments measured the association between MRM's independent variables (Stressors, Strains, Social Support, Coping, Coherence, Relative and Friend Support, and Hardiness) and MRM's dependent variables (Family Member Well-Being and Distress). The relationships between the scores of the FIRA-G and the FMWB were determined by Pearson Product Moment Correlation. Significant relationships were found between the factors identified in the MRM. The findings in this study suggest that significant relationships exist among the factors identified in the MRM and that the MRM maybe useful in studying AD populations. Ultimately, the use of the MRM may improve healthcare providers' ability to recognize and treat caregiver stress, which will in turn improve the home care of patients with AD.

Personality characteristics of spousal and adult children and active potential caregivers of persons with Alzheimer's Disease were studied in order to better predict caregiver burden and aspects of well-being. Contrary to prediction, no differences were found between spouse and adult children active caregivers on measures of well-being. Additionally, adult children potential caregivers indicated feeling less control over their lives than spouse potential caregivers. When social desirability was controlled, active caregivers reported greater fluctuations in affect than did potential caregivers. As predicted, personality characteristics of individuals were found to have the biggest role in determining which individuals experience stress or burden.

Accurate, early diagnosis of Alzheimer's Disease is becoming increasingly important in light of its growing prevalence among the expanding older-aged adult population. Due to its ability to assess multiple domains of cognitive functioning and provide a profile of impairment rather than a simple global score, the Neurobehavioral Cognitive Status Examination (NCSE) is suggested to better assess such patterns of cognitive deficit for the purpose of diagnosis. The performance of the NCSE was compared with that of the Mini-Mental State Examination (MMSE) for diagnostic sensitivity in a sample of patients diagnosed as having probable Alzheimer's Disease. The strength of correlation between severity of cognitive impairment on these tests and report of behavior problems on the Memory and Behavior Problems Checklist (MBPC) was also explored, as was performance on the NCSE and report of behavior problems using the MBPC in predicting Single Photon Emission Computed Tomography (SPECT) scan results. The NCSE was found to exhibit greater sensitivity to physician diagnosis of probable Alzheimer's Disease relative to two versions (Serial 7's or WORLD) of the MMSE (.90, .77 and .68, respectively). While both measures were found to correlate significantly with the report of behavior problems, only a moderate proportion (NCSE = .22 and MMSE = .33) of the explained variance was accounted for by either test. Severity of cognitive impairment on the NCSE was found to be significant, though small in estimate of its effect size, for predicting the absence/presence of pathognomic findings on SPECT scans. In contrast, the report of behavior problems on the MBPC did not significantly predict SPECT scan outcomes. The NCSE would appear to be a sensitive tool for the identification of the extent and severity of cognitive impairment found among demented individuals; however, it may be "over"-sensitive to such diagnosis. Although relationships between cognitive impairment and behavior problems and/or neuroradiological findings are observed, their meaningfulness remains with the need for further, more detailed, study using standardized criteria for comparison purposes.

Beta-Amyloid (1-40) (Aβ40) is an aggregation prone protein, which undergoes a nucleation-dependent aggregation process causing the pathological neurodegeneration by amyloid plaque formation implicated in Alzheimer’s disease. In this thesis, we investigated the effects of small molecule modulators extracted from the marine invertebrate Pseudopterogorgia elisabethae on the Aβ40 amyloidogenic process using in- vitro ThT fluorescence assay and atomic force microscopy. We also investigated the effects of neutral and anionic phospholipid liposomes on Aβ40 aggregation. Our results show that a marine natural product Pseudopterosin-A and its derivatives can suppress and modulate the Aβ40 aggregation process. Furthermore, our results demonstrate that a neutral phospholipid liposome inhibits Aβ40 fibril formation, whereas the anionic liposomes promote it. / Includes bibliography. / Thesis (M.S.)--Florida Atlantic University, 2015 / FAU Electronic Theses and Dissertations Collection