Background: Behavioral symptoms in patients with neurodegenerative diseases can be particularly challenging for caregivers. Previously, we reported that patients with frontotemporal dementia (FTD) and Alzheimer's disease (AD) experienced emotions that were atypical or incongruent with a given situation (i.e., non-target emotions). Aim: We tested the hypothesis that greater experience of non-target emotions by patients is associated with lower caregiver emotional well-being. Methods: 178 patients with FTD, AD, or other neurodegenerative diseases and 35 healthy individuals watched 3 films designed to induce amusement, sadness, and disgust, and then reported their emotions during the films. Caregivers of the patients reported their own emotional well-being on the Medical Outcomes Study 36-item Short-Form Health Survey. Results: In response to the amusement and sadness (but not disgust) films, greater experience of non-target emotions by patients was related to lower caregiver emotional well-being. These effects were specific to patients' experience of negative non-target emotions (i.e., not found for positive non-target emotions or for negative or positive target emotions). Conclusion: The findings reveal a previously unstudied patient behavior that is related to worse caregiver emotional well-being. Future research and clinical assessment may benefit from evaluating non-target emotions in patients.

Keywords:
Non-target emotion, Subjective emotional experience, Caregiver well-being, Neurodegenerative disease, Frontotemporal dementia, Alzheimer’s disease
1.
Schulz R, Martire LM: Family caregiving of persons with dementia: prevalence, health effects, and support strategies. Am J Geriatr Psychiatry 2004;12:240-249.
2.
Cuijpers P: Depressive disorders in caregivers of dementia patients: a systematic review. Aging Mental Health 2005;9:325-330.
3.
Joling KJ, van Hout HP, Schellevis FG, van der Horst HE, Scheltens P, Knol DL, van Marwijk HW: Incidence of depression and anxiety in the spouses of patients with dementia: a naturalistic cohort study of recorded morbidity with a 6-year follow-up. Am J Geriatr Psychiatry 2010;18:146-153.
4.
Lwi SJ, Ford BQ, Casey JJ, Miller BL, Levenson RW: Poor caregiver mental health predicts mortality of patients with neurodegenerative disease. Proc Natl Acad Sci USA 2017;114:7319-7324.
5.
Gaugler JE, Kane RL, Newcomer R: Resilience and transitions from dementia caregiving. J Gerontol B Psychol Soc Sci 2007;62:P38-P44.
6.
Schulz R, O'Brien AT, Bookwala J, Fleissner K: Psychiatric and physical morbidity effects of dementia caregiving: prevalence, correlates, and causes. Gerontologist 1995;35:771-791.
7.
Ornstein K, Gaugler JE: The problem with “problem behaviors”: a systematic review of the association between individual patient behavioral and psychological symptoms and caregiver depression and burden within the dementia patient-caregiver dyad. Int Psychogeriatr 2012;24:1536-1552.
8.
Eckart JA, Sturm VE, Miller BL, Levenson RW: Diminished disgust reactivity in behavioral variant frontotemporal dementia. Neuropsychologia 2012;50:786-790.
9.
Goodkind MS, Gyurak A, McCarthy M, Miller BL, Levenson RW: Emotion regulation deficits in frontotemporal lobar degeneration and Alzheimer's disease. Psychol Aging 2010;25:30-37.
10.
Goodkind MS, Sturm VE, Ascher EA, Shdo SM, Miller BL, Rankin KP, Levenson RW: Emotion recognition in frontotemporal dementia and Alzheimer's disease: a new film-based assessment. Emotion 2015;15:416.
11.
Otero M, Levenson RW: Lower visual avoidance in dementia patients associated with greater psychological distress in caregivers. Dement Geriatr Cogn Disord 2017;247-258.
12.
Keltner D, Haidt J: Social functions of emotions at four levels of analysis. Cogn Emot 1999;13:505-521.
13.
Levenson RW: The intrapersonal functions of emotion. Cogn Emot 1999;13:481-504.
14.
Levenson RW: Human emotion: a functional view; in Ekman P, Davidson RJ (eds): The Nature of Emotion: Fundamental Questions. New York, Oxford University Press, 1994, pp 123-126.
15.
Monin JK, Martire LM, Schulz R, Clark MS: Willingness to express emotions to caregiving spouses. Emotion 2009;9:101-106.
16.
Seeley WW, Crawford RK, Zhou J, Miller BL, Greicius MD: Neurodegenerative diseases target large-scale human brain networks. Neuron 2009;62:42-52.
17.
Chen K-H, Lwi SJ, Hua AY, Haase CM, Miller BL, Levenson RW: Increased subjective experience of non-target emotions in patients with frontotemporal dementia and Alzheimer's disease. Curr Opin Behav Sci 2017;77-84.
18.
Ware JE Jr, Sherbourne CD: The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992;30:473-483.
19.
Litvan I, Agid Y, Calne D, Campbell G, Dubois B, Duvoisin RC, Goetz CG, Golbe LI, Grafman J, Growdon JH, Hallett M, Jankovic J, Quinn NP, Tolosa E, Zee DS: Clinical research criteria for the diagnosis of progressive supranuclear palsy (Steele-Richardson-Olszewski syndrome): report of the NINDS-SPSP international workshop. Neurology 1996;47:1-9.
20.
Armstrong MJ, Litvan I, Lang AE, Bak TH, Bhatia KP, Borroni B, Boxer AL, Dickson DW, Grossman M, Hallett M, Josephs KA, Kertesz A, Lee SE, Miller BL, Reich SG, Riley DE, Tolosa E, Troster AI, Vidailhet M, Weiner WJ: Criteria for the diagnosis of corticobasal degeneration. Neurology 2013;80:496-503.
21.
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM: Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 1984;34:939-944.
22.
Strong MJ, Grace GM, Freedman M, Lomen-Hoerth C, Woolley S, Goldstein LH, Murphy J, Shoesmith C, Rosenfeld J, Leigh PN, Bruijn L, Ince P, Figlewicz D: Consensus criteria for the diagnosis of frontotemporal cognitive and behavioural syndromes in amyotrophic lateral sclerosis. Amyotroph Lateral Scler 2009;10:131-146.
23.
Rascovsky K, Hodges JR, Knopman D, Mendez MF, Kramer JH, Neuhaus J, et al: Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia. Brain 2011;134:2456-2477.
24.
Gorno-Tempini ML, Hillis AE, Weintraub S, Kertesz A, Mendez M, Cappa Se, emsp14, al, Ogar J, Rohrer J, Black S, Boeve BF: Classification of primary progressive aphasia and its variants. Neurology 2011;76:1006-1014.
25.
Levenson RW: Emotion elicitation with neurological patients; in Coan JA, Allen JJB (eds): Handbook of Emotion Elicitation and Assessment. New York, Oxford University Press, 2007, pp 158-168.
26.
Shiota MN, Levenson RW: Turn down the volume or change the channel? Emotional effects of detached versus positive reappraisal. J Pers Soc Psychol 2012;103:416-429.
27.
Gross JJ, Levenson RW: Emotion elicitation using films. Cogn Emot 1995;9:87-108.
28.
Derogatis LR, Unger R: Symptom Checklist-90-Revised. The Corsini Encyclopedia of Psychology. Hoboken, Wiley & Sons, Inc, 2010.
29.
Morris JC: The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 1993;43:2412-2414.
30.
Gross JJ, John OP: Facets of emotional expressivity: three self-report factors and their correlates. Pers Individ Dif 1995;19:555-568.
31.
Fredrickson BL, Levenson RW: Positive emotions speed recovery from the cardiovascular sequelae of negative emotions. Cogn Emot 1998;12:191-220.
32.
Fredrickson BL, Cohn M: Positive emotions; in Lewis MD, Haviland-Jones JM, Barrett LF (eds): Handbook of Emotions. New York, Guilford Press, 2007, pp 777-796.
33.
Terum TM, Andersen JR, Rongve A, Aarsland D, Svendsboe EJ, Testad I: The relationship of specific items on the Neuropsychiatric Inventory to caregiver burden in dementia: a systematic review. Int J Geriatr Psychiatry 2017;32:703-717.
34.
Haase CM, Holley SR, Bloch L, Verstaen A, Levenson RW: Interpersonal emotional behaviors and physical health: a 20-year longitudinal study of long-term married couples. Emotion 2016;16:965-977.
35.
Hooker K, Frazier LD, Monahan DJ: Personality and coping among caregivers of spouses with dementia. Gerontologist 1994;34:386-392.
© 2017 S. Karger AG, Basel
2017
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.