Moderators of the effect of stress exposure on executive functioning in spousal dementia caregivers

Abstract

Background. The challenges of dementia care may adversely affect caregivers’ executive functioning because of the impact of stress on prefrontal cognitive processes. We examined (1) whether greater psychological stress mediated a relationship between caregiver stress exposure and executive functioning and (2) whether greater self-efficacy and cognitive reserve moderated the indirect effect of stress exposure. Methods. Spousal dementia caregivers’ (n = 253) completed the Neuropsychiatric Inventory Questionnaire (stress exposure), the Perceived Stress Scale, the National Adult Reading Test (cognitive reserve), the Fortinsky dementia-specific caregiver self-efficacy scale, and the Color Trails Test (executive functioning). Moderated mediation was tested using the PROCESS macro in SPSS. Age, gender and dementia risk factors were included as covariates. Findings. Greater stress exposure indirectly predicted executive functioning through psychological stress. Stronger relationships between greater psychological stress and poorer executive functioning were observed among caregivers with lower cognitive reserve. However, there was no evidence that self-efficacy moderated the indirect effect of stress exposure on executive functioning through psychological stress. Discussion. Greater psychological stress in response to the challenges associated with dementia care may place caregivers at a greater risk of executive dysfunction. Having higher cognitive reserve may protect caregivers from the adverse effects of stress on cognition.