Caregiver Psychosocial Factors & Stroke Survivor Cognitive Outcomes: A REGARDS-CARES Cohort Study

IF 3.6 3区医学 Q2 GERIATRICS & GERONTOLOGY International Journal of Geriatric Psychiatry Pub Date : 2025-01-13 DOI:10.1002/gps.70046

Jason A. Blake, D. Leann Long, Amy J. Knight, Burel R. Goodin, Michael Crowe, Suzanne E. Judd, J. David Rhodes, Olivio J. Clay

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Abstract

Objectives

Caring for an individual with cognitive impairment carries a physical, mental, and emotional toll. This manuscript examines the relationship between caregiver psychosocial measures and longitudinal cognitive outcomes of stroke survivors, as well as analyzing the psychosocial factors as moderators of stroke severity and cognition.

Methods

This analysis was conducted on caregiver and stroke survivor dyads (n = 157) that participated in the Caring for Adults Recovering from the Effects of Stroke (CARES) project, an ancillary study of the REasons for Geographic and Racial Differences in Stroke (REGARDS) national cohort study. Stroke severity at hospitalization discharge was included as the primary predictor of cognitive outcomes and caregiver psychosocial factors were included as additional predictors. Cognition was assessed biennially and measured the domains of learning, memory, and executive functioning. Individual mixed-effect models included each psychosocial factor and were covariate-adjusted for pre-stroke cognitive scores and demographic variables. Caregiver psychosocial factors included caregiver strain, depressive symptoms, life and leisure time satisfaction, and overall quality of life.

Results

Decreased caregiver strain (b = −0.230, 95% CI: −0.39 to −0.07; p = 0.006) and increased leisure time satisfaction (b = 0.045, 95% CI: 0.01 to 0.08; p = 0.005) were both found to be significant predictors, alongside stroke severity (b = −0.137, 95% CI: −0.22 to −0.05; p = 0.002), of better stroke survivor cognition overall. No variables were found to be moderating factors of the relationship between stroke severity and cognition.

Conclusions

Understanding the caregiver psychosocial factors that predict stroke outcomes will help clinicians to identify stroke survivor and caregiver dyads at higher risk for worst longitudinal cognitive outcomes following stroke.

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照顾者心理社会因素与中风幸存者认知结果：一项关于照顾者的队列研究。

目的：照顾认知障碍患者需要付出身体、精神和情感上的代价。本文研究了照顾者的社会心理测量与中风幸存者的纵向认知结果之间的关系，并分析了社会心理因素对中风严重程度和认知的调节作用：本分析针对参与 "关爱中风后康复的成年人（CARES）"项目的照顾者和中风幸存者二元组（n = 157）进行，该项目是 "中风地域和种族差异原因（REGARDS）"全国队列研究的一项辅助研究。出院时的脑卒中严重程度被列为认知结果的主要预测因素，照顾者的社会心理因素被列为附加预测因素。认知能力每两年评估一次，测量学习、记忆和执行功能等领域。单个混合效应模型包括每个心理社会因素，并根据中风前的认知分数和人口统计学变量进行协变量调整。照顾者的心理社会因素包括照顾者压力、抑郁症状、生活和闲暇时间满意度以及整体生活质量：结果：除了卒中严重程度（b = -0.137，95% CI：-0.22 至 -0.05；p = 0.002）外，照顾者压力的减轻（b = -0.230，95% CI：-0.39 至 -0.07；p = 0.006）和闲暇时间满意度的提高（b = 0.045，95% CI：0.01 至 0.08；p = 0.005）都是卒中幸存者总体认知能力提高的重要预测因素。没有发现任何变量是中风严重程度与认知之间关系的调节因素：结论：了解预测中风预后的照顾者社会心理因素将有助于临床医生识别中风幸存者和照顾者二人组在中风后出现最差纵向认知预后的较高风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Geriatric Psychiatry 医学-精神病学

CiteScore

6.10

自引率

2.50%

发文量

168

审稿时长

4-8 weeks

期刊介绍： The rapidly increasing world population of aged people has led to a growing need to focus attention on the problems of mental disorder in late life. The aim of the Journal is to communicate the results of original research in the causes, treatment and care of all forms of mental disorder which affect the elderly. The Journal is of interest to psychiatrists, psychologists, social scientists, nurses and others engaged in therapeutic professions, together with general neurobiological researchers. The Journal provides an international perspective on the important issue of geriatric psychiatry, and contributions are published from countries throughout the world. Topics covered include epidemiology of mental disorders in old age, clinical aetiological research, post-mortem pathological and neurochemical studies, treatment trials and evaluation of geriatric psychiatry services.