Lower Visual Avoidance in Dementia Patients Is Associated with Greater Psychological Distress in Caregivers

Abstract

Caring for a spouse with dementia can lead to increased health problems in caregivers. The present study examined whether patient deficits in visual avoidance, a common form of emotion regulation, are related to greater psychological distress in caregivers. Participants were 43 Alzheimer disease (AD) patients, 43 behavioral variant frontotemporal dementia (bvFTD) patients, and their spousal caregivers. Patient visual avoidance (e.g., gaze aversion) was measured using behavioral coding of head, body, and eye position while viewing a disgusting film. Caregiver psychological distress was measured using a standard self-report symptom inventory. Lower use of visual avoidance by patients was associated with greater psychological distress in their caregivers. This relationship was partially mediated by patient overall emotional functioning (as reported by caregivers), such that patients with less visual avoidance were seen as having worse emotional functioning, which in turn related to greater caregiver psychological distress. Dementia diagnosis moderated this effect, with diminished patient visual avoidance particularly detrimental to psychological distress of bvFTD caregivers. Findings suggest that the use of visual avoidance may serve as a marker of overall emotional functioning in patients and that preservation of this emotion regulatory behavior may help reduce the negative effects of caregiving.

Keywords: Alzheimer disease; Caregiver psychological health; Emotion regulation; Frontotemporal dementia.

Conflict of interest statement

Conflicts of Interest Statement

This study was supported by the NIH under Grant R37AG017766. Preparation of this manuscript was supported by National Institute of Aging Grant P01AG019724 to Robert W. Levenson and a National Science Foundation Grant DGE 1106400 to Marcela C. Otero

Ms. Otero reports no disclosures or conflicts of interest.

Dr. Levenson reports no disclosures or conflicts of interest.

© 2017 S. Karger AG, Basel.

Figures

Figure 1

The relationship between patient visual avoidance and caregiver psychological distress was indirectly transmitted by patient overall emotional functioning, even when controlling for caregiver wellbeing. There was also a direct effect of patient visual avoidance on caregiver psychological distress. independent of patient emotional functioning. Data represent indirect and direct effects and standard errors using 10.000 bootstrap samples to obtain bias-corrected and accelerated 95% confidence intervals and p values.