Cognitive functioning under stress: evidence from informal caregivers of palliative patients

Abstract

Background: Caring for a terminally ill family member can be extremely stressful, and stress is known to have a negative influence on aspects of cognition. In contrast to the well-known physical and mental health risks associated with caregiving, little is known about its impact on cognitive functioning.

Objective: The primary objective of this study was to explore cognition among caregivers of palliative family members with a battery of neuropsychological tests. A secondary objective was to examine changes in cognition following caregiving by retesting a subset of participants at least 6 months after the death of their care recipient.

Method: While caregiving, 27 participants completed an assessment battery measuring attention, learning, and memory, as well as intelligence, mood, and general health; 22 participants completed this battery again post-caregiving. We compared caregivers' cognitive performance to healthy normative samples.

Results: Participants who were caring for palliative relatives exhibited significant impairments in attention, including difficulty monitoring their performance and regulating their attentional resources. In contrast, participants' episodic and working memory performance was not impaired while caregiving. A mixed pattern of improvement and worsening of cognitive functioning was evident among caregivers retested after their family member's death.

Conclusions: In addition to the well-documented physical and mental health risks associated with caregiving, this study adds to a small body of literature demonstrating impaired cognitive functioning among family members providing end-of-life care. Secondary findings of both improvement and deterioration of cognition post caregiving provide tentative support for the possibility of reversing certain cognitive deficits by reducing caregiver stress.

Figures

Figure 1.

Mean z-scores (± 95% CI) for 27 palliative caregivers during caregiving (Test 1) and 22 palliative caregivers at least six months after the death of care recipients (Test 2). High proactive and retroactive interference scores reflect low levels of interference, and vice versa. PI = Proactive Interference; RI = Retroactive Interference; LDFR = Long Delay Free Recall; LMII = Delayed Logical Memory; LNS = Letter Number Sequencing; S-Span = Spatial Span * Significantly different from z = 0, p <.05