Caregiver Coping Strategies Predict Cognitive and Functional Decline in Dementia: The Cache County Dementia Progression Study

Objectives: Few longitudinal studies have studied the influence of the care environment on the clinical progression of dementia. We examined whether caregiver coping strategies predict dementia progression in a population-based sample. Design: Longitudinal, prospective cohort study. Setting: Cache County (Utah) population. Participants: A total of 226 persons with dementia, and their caregivers, were assessed semiannually for up to 6 years. Measurements: Ways of Coping Checklist Revised, Mini-Mental State Examination (MMSE), and Clinical Dementia Rating (CDR). Results: Mean (SD) age of dementia onset in persons with dementia was 82.11 (5.84) years and mean caregiver age was 67.41 (13.95) years. Mean (SD) follow-up was 1.65 (1.63) years from baseline. In univariate linear mixed-effects models, increasing use of problem-focused and counting blessings by caregivers was associated with slower patient worsening on the MMSE. Problem-focused coping, seeking social support, and wishful thinking were associated with slower Clinical Dementia Rating Scale sum of boxes (CDR-sb) worsening Considering covariates, increasing use of problem-focused coping was associated with 0.70 points per year less worsening on the MMSE and 0.55 points per year less worsening on the CDR-sb. Compared with no use, the "regular" use of this strategy was associated with 2 points per year slower worsening on the MMSE and 1.65 points per year slower worsening on the CDR-sb. Conclusions: Caregiver coping strategies are associated with slower dementia progression. Developing interventions that target these strategies may benefit dementia patients. (Am J Geriat Psychiatry 2013; 21:57-66)