Cognitive Disorders Double Risk of Cognitive Impairment in Spouses

If your spouse had the stroke you will need to demand your doctor give you EXACT PROTOCOLS THAT PREVENT MCI OR DEMENTIA. Non-negotiable.

Cognitive Disorders Double Risk of Cognitive Impairment in Spouses

Cognitive disorders in older adults nearly doubled the risk of dementia or mild cognitive impairment in their spouses, a prospective cohort study showed.

Older people with a cognitive disorder -- defined as dementia or mild cognitive impairment -- were more likely to have a spouse with a cognitive disorder than people who were cognitively normal (OR 1.74, 95% CI 1.12-2.69, P=0.01), reported Ki Woong Kim, MD, PhD, of Seoul National University Bundang Hospital in Korea, and colleagues.

Shared environments may be responsible, in part, for shared cognitive disorders and cognitive performance within couples, they said.

"This study demonstrated that participants' cognitive disorders were associated with spouses' declines in cognitive function and risks of cognitive disorders, and that this association was mediated by factors including physical inactivity and a history of head injury, which were shared within couples," the researchers wrote in JAMA Network Open.

"To our knowledge, this is the first study to reveal how the association among cognitive disorders, cognitive function, and shared risk factors is structured within couples," they added.

The study followed 784 older adults who participated in the Korean Longitudinal Study on Cognitive Aging and Dementia (307 women and 477 men) and their opposite-sex spouses from 2010 to 2020 who were assessed every 2 years. Cognitive assessments included face-to-face diagnostic interviews conducted by geriatric psychiatrists. Participants had a mean age of about 75; spouses had a mean age of about 74.

Among the 784 participants, 121 people had cognitive disorders. Spouses of people with cognitive disorders were older, less educated, less physically active, and more likely to have a history of head injury compared with spouses of people who did not have a cognitive disorder. Cognitive disorders were more prevalent among people whose spouses had cognitive disorders (38.8%) than others (22.6%, P<0.001).

History of head injury (β=0.50 95% CI 0.09-0.90, P=0.02) and age (β=2.57, 95% CI 1.37-3.76, P<0.001) mediated the association between cognitive disorder in participants and their spouses' risk of cognitive disorder.

Physical inactivity mediated the association via major depressive disorder (β=0.33, 95% CI 0.09-0.57, P=0.006 for physical inactivity; β=0.28, 95% CI 0.13-0.44, P<0.001). Major depressive disorder was independently associated with increased risk of cognitive disorder (β=0.35, 95% CI 0.18-0.53, P<0.001).

These factors similarly mediated links between spousal cognitive disorder and memory and executive function.

This analysis shows that "almost 50% of the higher rates of cognitive disorders in spouses of persons with cognitive disorders could be explained by their age, history of major depressive disorder, limited physical activity, and history of head injury," wrote Peter Vitaliano, MS, PhD, of the University of Washington in Seattle, in an invited commentary.

"These findings support previous research and recommend the further study of three areas that are relevant to neurology and psychiatry: assortative mating, dyadic lifestyles, and spouse caregiving," Vitaliano suggested.

Assortative mating -- states and traits that influence a person's choice of a mate and future health -- may be associated with education, diet, or physical activity. Likewise, shared health habits in the dyad may be linked with cognitive outcomes: spouses may have similar chemical or stress exposures, for example.

Caregiving for a cognitively impaired spouse can create chronic stress, which may lead to physiological dysregulation, Vitaliano added. Cross-sectional studies have shown that chronic stress may affect the cognitive performance of spouse caregivers, he noted.

All grades of head injury are associated with increased risk of dementia, Kim and colleagues pointed out.

"In older people, falls are the leading cause of traumatic brain injury, and multiple factors, such as indoor home environment, physical frailty, compromised health status, and depressive symptoms, are associated with the risk of falls," they wrote. "These factors can be shared within couples and may increase the shared risk of head injury within couples."

Because the incidence of head injury was low and injury history was collected retrospectively, the mediating role of head injury needs to be confirmed in larger studies, they added.

Other limitations included the study's cross-sectional design; mediating variables may be symptoms, rather than risk factors, the researchers noted. In addition, dementia and mild cognitive impairment were not analyzed separately due to limited sample size.

• Judy George covers neurology and neuroscience news for MedPage Today, writing about brain aging, Alzheimer’s, dementia, MS, rare diseases, epilepsy, autism, headache, stroke, Parkinson’s, ALS, concussion, CTE, sleep, pain, and more. Follow

Disclosures

The study was supported by the Research of Korea Centers for Disease Control and Prevention (RKCDC).

Kim and co-authors disclosed support from RKCDC.

Vitaliano disclosed no relationships with industry.

Primary Source

JAMA Network Open

Source Reference: Yang HW, et al "Exploration of cognitive outcomes and risk factors for cognitive decline shared by couples" JAMA Netw Open 2021; DOI: 10.1001/jamanetworkopen.2021.39765.

Secondary Source

JAMA Network Open

Source Reference: Vitaliano PP "Exploration of risk factors for cognitive decline shared by couples and cognitive outcomes -- assortative mating, lifestyle, and chronic stress" JAMA Netw Open 2021; DOI: 10.1001/jamanetworkopen.2021.40678.

 

 

Discharge home after acute stroke: Differences between older and younger patients

Completely and totally the wrong conclusion. The solution you would have to propose is that before your stroke you get a caring and loving spouse. The goal should be 100% return to home. You haven't even identified the problem. The problem is that stroke rehab is a total fucking failure. You solve that by not having to provide very much of it. And that is by researching and creating protocols that stop the neuronal cascade of death in the first week.
http://www.ncbi.nlm.nih.gov/pubmed/26667264

Dutrieux RD¹, van Eijk M, van Mierlo ML, van Heugten CM, Visser-Meily JM, Achterberg WP.

Author information

Abstract

OBJECTIVE:

To identify determinants for discharge destination of older (≥ 70 years) and younger (< 70 years) acute stroke patients.

DESIGN:

Multicentre prospective cohort.

PATIENTS:

A total of 395 patients, within 7 days of clinically evaluated stroke, were included from 6 hospital stroke units.

METHODS:

The main outcome measure was discharge destination (home vs clinical rehabilitation). Independent variables were: demographic factors, stroke characteristics, functional impairments and disabilities, cognition, comorbidity, and premorbid social participation. Multivariate logistic regression analysis established the independent strength of the contribution of possible determinants to discharge destination.

RESULTS:

Seventy-six percent of younger patients were discharged home, compared with 63% of older patients. Most of the younger patients discharged to clinical rehabilitation (71%) had a spouse, whereas only 40% of the older age group discharged to clinical rehabilitation had a spouse. Multivariate analysis showed that, besides National Institutes of Health Stroke Scale and Barthel Index scores, having a spouse was an important determinant for discharge home in the older age group (adjusted odds ratio 4.77, 95% confidence interval 2.01-11.31), but not in the younger age group.

CONCLUSION:

The presence of a spouse is an additional important factor determining discharge home in older stroke patients. It is important to monitor and support informal caregivers in order to provide appropriate care for older community-dwelling stroke patients.

PMID:

26667264

[PubMed - as supplied by publisher]

Spouses of stroke survivors face lingering health issues

Well, my former spouse doesn't have to  worry about me any more. Not that she worried about helping my recovery.
http://www.alphagalileo.org/ViewItem.aspx?ItemId=155383&CultureCode=en
Caregiver spouses of stroke survivors are at an increased risk of mental and physical health issues that may continue for years, according to research in the American Heart Association journal Stroke.
Swedish researchers evaluated 248 stroke survivors, below age 70 (average mid-sixties), and their spouses at stroke onset and compared the results with 245 non-stroke controls for seven years after the stroke event.
At the seven-year follow-up, 16.5 percent of survivors had suffered a recurrent stroke. Spouses of survivors reported lower scores in several mental and physical areas — more health issues affecting their lives, less vitality, and reduced social function — not only during the first years after stroke but also in the long-term.
Caregivers’ quality of life was most adversely affected by their spouses’ level of disability, cognitive difficulties and depressive symptoms.
“It is known that spouses of older stroke patients experience health-related physical and mental issues, and that the degree of their problems is associated with the severity of the stroke, but ours is the first long-term study of seven years follow up to explore this in a younger group of people,” said Josefine Persson, M.Sc., study author and a researcher and Ph.D. candidate at the Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Sweden.
“Our results also highlight the impact on the spouses’ mental health due to demanding changes in the life situations of these families, not only during the first years after stroke onset but also in the long term.”
Researchers said juggling work and caregiving is different among younger and older caregivers. “Caring for a spouse after a stroke can be demanding and can reduce a husband or wife’s time spent at their occupation, which also can be a burden for many younger families, and the underlying problems can continue several years,” Persson said. The findings also have implications for healthcare policymakers and calls attention to the need for greater social support for these individuals, she said.
Researchers surveyed spouses with questionnaires to measure their health status and calculate their quality of life. Age, children, education and work status were also included in the review.
They made subjective reports of mental health, vitality, social functioning and emotional status of spouses by phone questionnaires or face-to-face evaluation.
The stroke survivors underwent standardized tests to assess the severity of their stroke, degree of disability and dependence on caregivers, body pain, daily living activities, depression and anxiety.
http://newsroom.heart.org/news/spouses-of-stroke-survivors-face-lingering-health-issues?preview=62f1dfa19e5007e79073d648a2d1a1fe

After Stroke, Spouse May Also Need Care

For me it was quite simple. Since I wasn't following therapist instructions to the letter I was not going to recover.  My ex had the expectation that all I had to do to recover was follow the therapist instructions.  I couldn't disagree because I had no medical background and disagreeing with her was attacking and saying her medical background was not worth listening to.  Whoa!
http://health.usnews.com/health-news/articles/2014/06/26/after-stroke-spouse-may-also-need-care
If your spouse has a stroke, and the two of you disagree about the rate of recovery, your own health might suffer, a new study finds.
The caregiving spouse is at increased risk for emotional distress and depression if the couple has different perceptions of the post-stroke progress, researchers found.
Stroke care needs to switch from focusing only on the patient to regarding the patient and spouse as one unit, suggested Michael McCarthy, a social work researcher at the University of Cincinnati.
"How the spouse is doing matters in the equation," McCarthy said.
"They need as much care, if not more in some ways, as the patient," he added. "We need to bring partners together in the rehabilitation process, to align each person's expectations and perceptions in order to achieve the best outcomes."

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