Greater levels of psychological distress, sleep disturbance and social isolation may place dementia caregivers at a greater risk of executive dysfunction

Background: Dementia caregivers are reported to be at an increased risk of cognitive decline themselves because of the chronic and often severe stress associated with providing dementia care. The impact of dementia caregiving on cognitive functioning may be mediated by psychosocial risk factors for cognitive decline/dementia that are known to be more prevalent among caregivers than non-caregivers. This study examined (1) whether caring for a spouse with dementia predicted poorer executive functioning and (2) whether relationships between caregiver status and cognitive performance were mediated by poorer psychological wellbeing, greater sleep disturbances and greater social risk factors (isolation and loneliness). Methods: Eight-hundred and fifty community-dwelling older adults living in Ireland (caregiver n = 253) completed a test battery that included measures of executive functioning and as well as standardised scales to assess stress, anxiety and depression, sleep disturbance, social isolation and loneliness. A structural equation model with the maximum likelihood estimator and a full information likelihood approach to missingness was used to evaluate relationships between caregiver status, psychological distress, social risk factors, sleep disturbance, and executive function, controlling for age, gender, dementia risk score and grip strength (frailty) as covariates. Results: We found that lower executive function performance was predicted by dementia caregiver status (β = -.048, p<.001)., along with higher scores for psychological distress (β =-.076, p=.04), social risk factors (β = -.102, p=.007) and sleep disturbance (β = --.443, p=.002). Caregiver status was positively associated with sleep disturbance (β =.012, p=.008), social risk (β = .070, p=.005), and psychological distress (β =.141, p=.005). Conclusion: The negative relationships between dementia caregiver status and executive functioning may be at least partly explained by higher levels of psychological distress, social risk factors (isolation and loneliness) and sleep disturbances among this group