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.

Greater Experience of Negative Non-Target Emotions by Patients with Neurodegenerative Diseases Is Related to Lower Emotional Well-Being in Caregivers

“…Given the increasing rates of neurodegenerative diseases and associated caregiving, there is an urgent need to identify particular factors that influence vulnerability to the negative effects of caregiving. Aggregating the present findings with our previous findings on the association between visual avoidance in patients and mental health in caregivers [11], we suggest that a comprehensive (e.g., emotion reactivity, regulation, and recognition) and detailed (e.g., target and non-target emotions) assessment of patient emotional functioning will be helpful in developing a more complete understanding of associations between particular patient behaviors and particular adverse caregiver outcomes, which may benefit both the caregivers and patients [4]. …”

“…In our own work, we have found that neurodegenerative diseases can produce profound changes in patients’ emotional behavior, including alterations in reactivity (generating emotional responses [8]), regulation (adjusting emotional responses [9]), and recognition (identifying emotions in others [10]). Importantly, we have found that deficits in patients’ emotional functioning (i.e., less frequent use of visual avoidance from negative stimuli – a specific type of emotion dysregulation) are associated with adverse outcomes in caregivers (e.g., greater psychological distress [11]). In the present study, we examine the impact of deficits in patient emotional reactivity on caregiver well-being, with a particular focus on subjective emotional experience.…”

Relationship Turmoil and Emotional Empathy in Frontotemporal Dementia

“…In addition, many studies have consistently demonstrated that patients with bvFTD have marked difficulties with emotion recognition, which is critical for successful social interactions (20)(21)(22). Patients with bvFTD also have deficits in emotion regulation that are associated with the psychological distress of their caregivers (23). The inability of patients with bvFTD to read or regulate emotions results in misunderstanding meaning in situations and responding empathically (6).…”

Emotion regulation via visual avoidance: Insights from neurological patients

“…Moreover, attentional deficits have been linked with decreases in quality of life in patients with dementia, highlighting the real-world consequences of abnormal attentional processing (Lawson et al, 2016). Focusing on visual avoidance per say, prior research from our group has linked deficits in visual avoidance among patients with behavioral variant frontotemporal dementia (bvFTD) and Alzheimer's disease (AD) with greater psychological distress in spousal caregivers (Otero and Levenson, 2017), which is consistent with the important role that emotion regulation plays in interpersonal contexts.…”