In this Issue

Moderator analyses were performed by Rabinowitz et al. (pg.642) to determine if self-efficacy predicted differential out-come in a randomized trial of female caregivers of older adultrelatives with dementia which compared a cognitive behav-ioral psychoeducational intervention (CWC) and an enhancedsupport group (ESG). Low baseline self-efficacy scores betterpredicted positive response to treatment in the CWC interven-tion than in the ESG intervention, confirming the hypotheses.This study supports the utility of self-efficacy as a screeningtool for appropriate intervention assignment.

Schulz et al. (pg. 650) found that 20% of caregivers of patientswith dementia whose care recipient died during follow-updeveloped complicated grief. Caregivers who participated in apsychosocial caregiver intervention were less likely to experi-ence complicated grief. Also, caregivers who found benefit incaregiving (made them feel useful or important) had highlevels of burden and depression prior to death and were morelikely to exhibit complicated grief. These findings have impor-tant implications for treatment for caregivers providing end-of-life care.

Hirschman et al. (pg. 659), in their study, state family mem-bers of persons with advanced dementia were just as likely touse the best interest standard as the substituted judgmentwhen making medical decisions for their relative. Reasons fornot using the substituted judgment standard included theneed for family consensus, unrealistic expectations of the pa-tient, the need to incorporate their relative’s quality of life intothe decision and the authority of health care professionals.These data suggest that the hierarchy of substituted judgmentover best interests may not correspond to the practice ofcaregivers.

Assisted living (AL) is an expanding residential option for thesenior population, though little is known about dementiaawareness and treatment. To learn more, Maust et al. (pg. 668)used data from the Maryland Assisted Living Study, whichexamines a cross-section of AL facilities in central Maryland.Less severe cognitive and functional impairment, fewer psy-chiatric symptoms and male gender were predictors of care-giver unawareness of dementia; family and caregiver un-awareness and female gender were predictors of failure totreat.

Gallagher-Thompson et al. (pg. 676) describe the relativeeffectiveness of three different types of outreach for enrollingChinese dementia family caregivers into an intervention re-search project. The most effective method was referrals fromChinese health care professionals, who already knew the fam-ily and whom the family trusted. The least effective methodwas informal sources (such as friends). Media was betweenthese two: apparently some Chinese caregivers were comfort-able acting on information received in flyers or newsletters.Use of the Chinese language (as well as English) seemedcritical to success.

This pilot study by McCallum et al. (pg. 684) examines therelationship between depression, stress, and cortisol patternsamong African-American and European-American womencaring for relatives with dementia. Participants completedmental health measures and recorded daily cortisol output.African-American caregivers scored higher than European-American caregivers on the stress resilience measure, and alsorecorded flatter cortisol slopes (which may indicate morephysiological stress). Statistical analyses determined that ageand ethnicity predicted the pattern of daily cortisol output.

Aschbacher et al. (pg. 694), in their study, acknowledge care-givers of spouses with Alzheimer diseases exhibit elevatedlevels of the clotting factor, D-dimer, associated with increasedcardiovascular risk. However, the progressive effects of spou-sal dementia severity on caregiver health over time are incom-pletely understood. Care recipient dementia severity and care-giver D-dimer were measured among 71 elderly caregivingdyads and 37 non-caregiving dyads (average age: 71 years).Dementia severity of the care recipient was associated withincreasing hypercoagulability among elderly caregivers.

The study by Peskind et al. (pg. 704) compared the efficacyand safety of memantine versus placebo in patients with mildto moderate Alzheimer disease. Participants were randomizedto receive 20mg/day memantine (N � 201) or placebo (N �202) for 24 weeks. Memantine resulted in significantly betteroutcomes than placebo on measures of global status, cogni-tion, and behavior. Treatment discontinuation was 9.5% formemantine, and 5.0% for placebo. Adverse events were simi-lar in both groups.