Caring for a family member with dementia is generally regarded as a chronically stressful process, with potentially negative physical health consequences. However, no quantitative analysis has been conducted on this literature. The authors combined the results of 23 studies to compare the physical health of caregivers with demographically similar noncaregivers. When examined across 11 health categories, caregivers exhibited a slightly greater risk for health problems than did noncaregivers. However, sex and the health category assessed moderated this relationship. Stronger relationships occurred with stress hormones, antibodies, and global reported health. The authors argue that a theoretical model is needed that relates caregiver stressors to illness and proffers moderating roles for vulnerabilities and resources and mediating roles for psychosocial distress and health behaviors.

Objectives. The Mini‐Cog, a composite of three‐item recall and clock drawing, was developed as a brief test for discriminating demented from non‐demented persons in a community sample of culturally, linguistically, and educationally heterogeneous older adults. Subjects. All 129 who met criteria for probable dementia based on informant interviews and 120 with no history of cognitive decline were included; 124 were non‐English speakers. Methods. Sensitivity, specificity, and diagnostic value of the Mini‐Cog were compared with those of the Mini‐Mental State Exam (MMSE) and Cognitive Abilities Screening Instrument (CASI). Results. The Mini‐Cog had the highest sensitivity (99%) and correctly classified the greatest percentage (96%) of subjects. Moreover, its diagnostic value was not influenced by education or language, while that of the CASI was adversely influenced by low education, and both education and language compromised the diagnostic value of the MMSE. Administration time for the Mini‐Cog was 3 minutes vs 7 minutes for the MMSE. Conclusions. The Mini‐Cog required minimal language interpretation and training to administer, and no test forms of scoring modifications were needed to compensate for the extensive linguistic and educational heterogeneity of the sample. Validation in clinical and population‐based samples is warranted, as its brevity and ease of administration suggest that the Mini‐Cog might be readily incorporated into general practice and senior care settings as a routine ‘cognitive vital signs’ measure. Copyright © 2000 John Wiley & Sons, Ltd.

Checklist (RMBPC), a 24-item, caregiver-report measure of observable behavioral problems in dementia patients, provides 1 total score and 3 subscale scores for patient problems (memory-related, depression, and disruptive behaviors) and parallel scores for caregiver reaction. Data were obtained from 201 geriatric patients and their caregivers. Factor analysis confirmed 3 first-order factors, consistent with subscales just named, and 1 general factor of behavioral disturbance. Overall scale reliability was good, with alphas of .84 for patient behavior and .90 for caregiver reaction. Subscale alphas ranged from .67 to .89. Validity was confirmed through comparison of RMBPC scores with well-established indexes of depression, cognitive impairment, and caregiver burden. The RMBPC is recommended as a reliable and valid tool for the clinical and empirical assessment of behavior problems in dementia patients.

This study examined the psychometric properties of the "original" seven factored scales derived by Aldwin et al. from Folkman and Lazarus' Ways of Coping Checklist (WCCL) versus a revised set of scales. Four psychometric properties were examined including the reproducibility of the factor structure of the original scales, the internal consistency reliabilities and intercorrelations of the original and the revised scales, the construct and concurrent validity of the scales, and their relationships to demographic factors. These properties were studied on three distressed samples: 83 psychiatric outpatients, 62 spouses of patients with Alzheimer's disease, and 425 medical students. The revised scales were consistently shown to be more reliable and to share substantially less variance than the original scales across all samples. In terms of construct validity, depression was positively related to the revised Wishful Thinking Scale and negatively related to the revised Problem-Focused Scale consistently across samples. Anxiety was also related to these scales, and in addition, it was positively related to the Seeks Social Support Scale across samples. The Mixed Scale was the only original scale that was consistently related to depression and anxiety across the three samples. Evidence for concurrent validity was provided by the fact that medical students in group therapy had significantly higher original and revised scale scores than students not participating in such groups. Both sets of scales were shown to be generally free of demographic biases.

In older men, pathways occurred from chronic stress to distress to the metabolic syndrome, which in turn predicted CHD. Older women not using HRT showed fewer pathways than men; however, over time, distress, the MS, and CHD were related. No psychophysiological pathways occurred in older women using HRT.

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Raw scores (frequency of efforts) versus relative scores (percentage of efforts) were compared on the five scales of the revised Ways of Coping Checklist. It was hypothesized that, conditional on the source of and appraisal of a stressor, problem-focused coping should be inversely related and Wishful Thinking should be positively related to depression when relative scores were used but that raw problem-focused scores would be less clearly related to depression in such a way. It was further hypothesized that these relationships would hold for very diverse samples: psychiatric outpatients (n = 145), spouses of patients with Alzheimer's disease (n = 66), and medical students (n = 185). Given the maladaptive status of the psychiatric outpatients, it was hypothesized that they would report more emotion-focused strategies and less problem-focused coping than the nonclinical samples and that these differences would be better observed using relative rather than raw scores. The hypotheses were generally supported.

The goodness of fit among the appraised changeability of a stressor, coping, and depression in people with psychiatric, physical health, work, and family problems was examined (N = 746). It was expected that problem-focused coping (as opposed to emotion-focused coping) would be used more and be more adaptive in situations appraised as changeable as compared with situations appraised as not changeable. Although few relationships existed between appraisal and coping, tests of fit between coping and depressed mood (maladaption) were much stronger. In people with nonpsychiatric conditions, problem-focused coping and depressed mood were negatively related when a stressor was appraised as changeable but were unrelated when a stressor was appraised as not changeable. Emotion-focused coping was positively related to depression when a stressor was appraised as changeable. No general relations were observed in the people with psychiatric conditions.