Associations of knowledge about Alzheimer's disease, dysfunctional cognition, and coping with caregiver's blood pressure

  1. Carlos Vara-García 1
  2. Rosa Romero-Moreno 1
  3. María Márquez-González 2
  4. Samara Barrera-Caballero 1
  5. María del Sequeros Pedroso-Chaparro 1
  6. Andrés Losada-Baltar 1
  1. 1 Universidad Rey Juan Carlos
    info

    Universidad Rey Juan Carlos

    Madrid, España

    ROR https://ror.org/01v5cv687

  2. 2 Universidad Autónoma de Madrid
    info

    Universidad Autónoma de Madrid

    Madrid, España

    ROR https://ror.org/01cby8j38

Revista:
Clínica y salud: Investigación Empírica en Psicología

ISSN: 1130-5274

Año de publicación: 2021

Volumen: 32

Número: 2

Páginas: 79-87

Tipo: Artículo

DOI: 10.5093/CLYSA2020A33 DIALNET GOOGLE SCHOLAR lock_openAcceso abierto editor

Otras publicaciones en: Clínica y salud: Investigación Empírica en Psicología

Resumen

El pensamiento disfuncional acerca del cuidado o el inadecuado afrontamiento del mismo han sido asociados con una peor salud física de los cuidadores. El objetivo de este estudio es analizar las asociaciones entre el conocimiento de los cuidadores sobre la enfermedad de Alzheimer, los pensamientos disfuncionales, la evitación experiencial y la presión arterial. Los participantes de este estudio fueron 123 cuidadores de un familiar con demencia. Un modelo de senderos fue empleado para analizar la relación entre las variables. El modelo obtenido muestra que existe un relación negativa y significativa entre el conocimiento de los cuidadores acerca de la enfermedad d Alzheimer y la presión arterial sistólica, potencialmente medida por los pensamientos disfuncionales y la evitación experiencial de los cuidadores. Los resultados de este estudio apoyan la idea de que una falta de conocimiento acerca de la enfermedad de Alzheimer puede contribuir a cogniciones desadaptativas acerca del cuidado, incrementando el riesgo cardiovascular de los cuidadores.

€ Ver financiación

Información de financiación

The preparation of this paper was supported in part by grants from the Spanish Ministry of Economy and Competitiveness under grants PSI2012-31239 and PSI2015-65152-C2-1-R, and by the Comunidad Aut?noma de Madrid, through a pre-doctoral scholarship for the first author of this work. Samara Barrero was supported by a FPU grant from the Spanish Ministry of Education, Culture and Sport.

Financiadores

Referencias bibliográficas

  • References Beck, A. T., Rush, J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of
  • depression. Guilford Press. Bollen, K. A. (1989). A new incremental fit index for general structural
  • equation models. Sociological Methods and Research, 17(3), 303-316. https://doi.org/10.1177/0049124189017003004
  • Bollen, K. A., & Stine, R. A. (1992). Bootstrapping goodness-of-fit measures in structural equation models. Sociological Methods and Research, 21(2), 205-229. https://doi.org/10.1177/0049124192021002004
  • Byrne B. M. (2016). Structural equation modeling with AMOS: Basic concepts, applications, and programming. Routledge.
  • Capistrant, B. D., Moon, J. M., & Glymour, M. M. (2012). Spousal caregiving and incident hypertension. American Journal of Hypertension, 25(4), 437-443. https://doi.org/10.1038/ajh.2011.232
  • Carpenter, B. D., Balsis, S., Otilingam, P. G., Hanson, P. K., & Gatz, M. (2009). The Alzheimer’s Disease Knowledge Scale: Development and psychometric properties. The Gerontologist, 49(2), 236-247. https:// doi.org/10.1093/geront/gnp023
  • Carpenter, B. D., Zoller, S. M., Balsis, S., Otilingam, P. G., & Gatz, M. (2011). Demographic and contextual factors related to knowledge about Alzheimer’s disease. Alzheimer Disease and Associated Disorders Other Dementias, 26(2), 121-126. https://doi.org/10.1177/1533317510394157
  • Carver, C. S. (2011). Coping. In R. C. Contrada & A. Baum (Eds.). The Handbook of stress sciences: Biology, psychology and health. Springer Publishing Company.
  • Chattillion, E. A., Ceglowski, J., Roepke, S. K., von Känel, R., Losada, A., Mills, P. J., Romero-Moreno, R., Grant, I., Patterson, T. L., & Mausbach, B. T. (2013). Pleasant events, activity restriction, and blood pressure in dementia caregivers. Health Psychology, 32(7), 793-801. https://doi. org/10.1037/a0029412
  • Chattillion, E. A., Mausbach, B. T., Roepke, S. K., von Känel, R., Mills, P. J., Dimsdale, J. E., Allison, M., Ziegler, M. G., Patterson, T. L., AncoliIsrael, S., & Grant, I. (2012). Leisure activities, caregiving demands and catecholamine levels in dementia caregivers. Psychology and Health, 27(10), 1134-1149. https://doi.org/10.1080/08870446.2011.637559
  • Chien, H. & Tann, D. B. (2019).Study of an educational programme in dementia care for family carers in Taiwan. Educational Gerontology, 45(2), 94-104. https://doi.org/10.1080/03601277.2019.1581476
  • Cohen, B. E., Edmondson, D., & Kronish, I. M. (2015). State of the art review: depression, stress, anxiety, and cardiovascular disease. American Journal of Hypertension, 28(11), 1295-1302. https://doi.org/10.1093/ ajh/hpv047
  • Cooper, C., Balamurali, T. B. S., & Livingston, G. (2007). A systematic review of the prevalence and covariates of anxiety in caregivers of people with
  • https://doi.org/10.1177/1533317510394157
  • https://doi.org/10.1037/a0029412
  • https://doi.org/10.1037/a0029412
  • https://doi.org/10.1093/ajh/hpv047
  • https://doi.org/10.1093/ajh/hpv047
  • dementia. International Psychogeriatrics, 19(2), 175-195. https://doi. org/ 10.1017/S1041610206004297
  • Dilworth-Anderson, P., Goodwin, P. Y., & Williams, S. W. (2004). Can culture help explain the physical health effects of caregiving over time among African American caregivers? The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 59(3), S138-S145. https:// doi.org/10.1093/geronb/59.3.S138
  • Folkman, S., & Lazarus, R. S. (1980). An analysis of coping in a middle-aged community sample. Journal of Health and Social Behavior, 21(3), 219- 239. https://doi.org/10.2307/2136617
  • Gilhooly, K. J., Gilhooly, M. L. M., Sullivan, M. P., McIntyre, A., Wilson, L., Harding, E., Woodbridge, R., & Crutch, S. (2016). A meta-review of stress, coping and interventions in dementia and dementia caregiving. BMC Geriatrics, 16, e106. https://doi.org/10.1186/s12877-016-0280-8
  • Gómez-Carretero, P., Soriano Pastor, J. F., Monsalve Dolz, V., & de Andrés Ibáñez, J. (2009). Satisfacción con la información: posible variable interviniente en el estado de ánimo de cuidadores primarios de pacientes críticos. Clinica y Salud, 20(1), 91-105. https://journals. copmadrid.org/clysa/archivos/cl2009v20n1a7.pdf
  • Graham, C., Ballard, C., & Sham, P. (1997). Carers’ knowledge of dementia, their coping strategies and morbidity. International Journal of Geriatric Psychiatry, 12(9), 931-936. https://doi.org/10.1002/(SICI)1099- 1166(199709)12:9<931::AID-GPS666>3.0.CO;2-8
  • Harmell, A. L., Mausbach, B. T., Roepke, S. K., Moore, R. C., von Känel, R., Patterson, T. L., Dimsdale, J. E., Mills, P. J., Ziegler, M. G., Allison, M. A., Ancoli-Israel, S., & Grant, I. (2011). The relationship between selfefficacy and resting blood pressure in spousal Alzheimer’s caregivers. British Journal of Health Psychology, 16(2), 317-328. https://doi. org/10.1348/135910710X504932
  • Hildebrandt, M. J., & Hayes, S. C. (2012). The contributing role of negative affectivity and experiential avoidance to increased cardiovascular risk. Social and Personality Psychology Compass, 6(8), 551-565. https://doi. org/10.1111/j.1751-9004.2012.00448.x
  • Imre, N., Balogh, R., Papp, E., Kovács, I., Heim, S., Karádi, K., Hajnal, F., Kálmán, J., & Pákáski, M. (2019). Knowledge of general practitioners on dementia and mild cognitive impairment: A cross-sectional, questionnaire study from Hungary. Educational Gerontology, 45(8), 495-505. https://doi.org/10.1080/03601277.2019.1660137
  • Ingjaldsson J. T., Laberg J. C., & Thayer J. F. (2003). Reduced heart rate variability in chronic alcohol abuse: Relationship with negative mood, chronic thought suppression, and compulsive drinking. Biological Psychiatry, 54(12), 1427-1436. https://doi.org/10.1016/S0006- 3223(02)01926-1
  • Izal, M., Montorio, I., Marquez, M., & Losada, A. (2005). Caregivers’ expectations and care receivers’ competence: Lawton’s ecological model of adaptation and aging revisited. Archives of Gerontology and Geriatrics, 41(2), 129-140. https://doi.org/10.1016/j.archger.2005.01.001
  • Jöreskog, K. G., & Sörbom, D. (1993). LISREL 8: Structural equation modeling with the SIMPLIS command language. Scientific Software International.
  • Kim, J. H., Knight, B. G., & Flynn-Longmire, C. V. (2007). The role of familism in stress and coping processes among African American and White dementia caregivers: Effects on mental and physical health. Health Psychology, 26(5), 564-576. https://doi.org/10.1037/0278- 6133.26.5.564
  • Kingston, J., Clarke, S., & Remington, B. (2010). Experiential avoidance and problem behavior: A mediational analysis. Behavior Modification, 34(2), 145-163. https://doi.org/10.1177/0145445510362575
  • Kishita, N., Hammond, L., Dietrich, C. M., & Mioshi, E. (2018). Which interventions work for dementia family carers? An updated systematic review of randomized controlled trials of carer interventions. International Psychogeriatrics, 30(11), 1679-1696. https://doi. org/10.1017/S1041610218000947
  • Knight, B. G., Robinson, G. S., Flynn-Longmire, C. V., Chun, M., Nakao, K. & Kim, J. H. (2002). Cross cultural issues in caregiving for persons with dementia: Do familism values reduce burden and distress? Ageing International, 27, 70-94. https://doi.org/10.1007/s12126-003-1003-y
  • Kohlmann, C. W., Weidner, G., & Messina, C. R. (1996). Avoidant coping style and verbal-cardiovascular response dissociation. Psychology and Health, 11(3), 371-384. https://doi.org/10.1080/08870449608400265
  • Kovaleva, M., Blevins, L., Griffiths, P. C., & Hepburn, K. (2019). An online program for caregivers of persons living with dementia: Lessons learned. Journal of Applied Gerontology, 38(2), 159-182. https://doi. org/10.1177/0733464817705958
  • Kuiper, N. A., Olinger, L. J., & Air, P. A. (1989). Stressful events, dysfunctional attitudes, coping styles, and depression. Personality and Individual Differences, 10(2), 229-237. https://doi.org/10.1016/0191- 8869(89)90208-0
  • Lazarus, R., & Folkman, S. (1984). Stress, appraisal and coping. Springer Publishing Company.
  • Lopresti, A. L. (2017). Cognitive behaviour therapy and inflammation: A systematic review of its relationship and the potential implications for the treatment of depression. Australian & New Zealand Journal of Psychiatry, 51(6), 565-582. https://doi.org/10.1177/0004867417701996
  • Losada, A., Márquez-González, M., Knight, B. G., Yanguas, J., Sayegh, P., & Romero-Moreno, R. (2010). Psychosocial factors and caregivers’ distress:
  • Effects of familism and dysfunctional thoughts. Aging and Mental Health, 14(2), 193-202. https://doi.org/10.1080/13607860903167838
  • Losada, A., Márquez-González, M., Romero-Moreno, R., & López, J. (2014). Development and validation of the Experiential Avoidance in Caregiving Questionnaire (EACQ). Aging and Mental Health, 18(7), 897-904. https:// doi.org/10.1080/13607863.2014.896868
  • Losada, A., Márquez-González, M., Romero-Moreno, R., López, J., FernándezFernández, V., & Nogales-González, C. (2015). Atendiendo a las variadas problemáticas de los cuidadores familiares de personas con demencia: aportaciones de la terapia cognitivo-conductual y de la terapia de aceptación y compromiso. Clínica y Salud, 26(1), 41-48. http://doi. org/10.1016/j.clysa.2015.02.001
  • Losada, A., Montorio, I., Izal, M., & Márquez-González, M. (2006). Estudio e intervención sobre el malestar psicológico de los cuidadores de personas con demencia. El papel de los pensamientos disfuncionales [Study and intervention on dementia caregiving distress. The role of dysfunctional thoughts] (1st ed.). IMSERSO.
  • Losada, A., Montorio, I., Knight, B. G., Márquez, M., & Izal, M. (2006). Explanation of caregivers distress from the cognitive model: The role of dysfunctional thoughts. Behavioral Psychology, 14(1), 115-128. https://www.behavioralpsycho.com/wp-content/uploads/2020/04/08. Losada_14- 1oa-1.pdf
  • Lwi, S. J., Ford, B. Q., Casey, J. J., Miller, B. L, & Levenson, R. W. (2017). Poor caregiver mental health predicts mortality of patients with neurodegenerative disease. PNAS, 114(28), 7319-7324. https://doi. org/10.1073/pnas.1701597114
  • Mahoney, F. I., & Barthel, D. W. (1965). Functional evaluation: The Barthel Index: A simple index of independence useful in scoring improvement in the rehabilitation of the chronically ill. Maryland State Medical Journal, 14, 61-65. https://pubmed.ncbi.nlm.nih.gov/14258950/
  • Márquez-González, M., Cabrera, I., Losada, A., & Knight, B. G. (2018). Attentional avoidant biases as mediators in the association between experiential avoidance and blood pressure in dementia family caregivers. Aging and Mental Health, 22(5), 669-677. http://doi.org/10.1080/13607863.2017.12 93003
  • Mausbach, B. T., Aschbacher, K., Patterson, T. L., Ancoli-Israel, S., von Känel, R., Mills, P. J., Dimsdale, J. E., & Grant, I. (2006). Avoidant coping partially mediates the relationship between patient problem behaviors and depressive symptoms in spousal Alzheimer caregivers. The American Journal of Geriatric Psychiatry, 14(4), 299-306. https://doi.org/10.1097/01. JGP.0000192492.88920.08
  • Mausbach, B. T., Chattillion, E., Roepke, S. K., Ziegler, M. G., Milic, M., von Känel, R., Dimsdale, J. E., Mills, P. J., Patterson, T. L., Allison, M. A., Ancoli-Israel, S., & Grant, I. (2012). A longitudinal analysis of the relations among stress, depressive symptoms, leisure satisfaction, and endothelial function in caregivers. Health Psychology, 31(4), 433-440. https://doi.org/10.1037/ a0027783
  • Mausbach, B. T., Patterson, T. L., Rabinowitz, Y. G., Grant, I., & Schulz, R. (2007). Depression and distress predict time to cardiovascular disease in dementia caregivers. Health Psychology, 26(5), 539-544. http://doi. org/10.1037/0278-6133.26.5.539
  • Mausbach, B. T., von Känel, R., Roepke, S. K., Moore, R., Patterson, T. L., Mills, P. J., Dimsdale, J. E., Ziegler, M. G., Ancoli-Israel, S., Allison, M., & Grant, I. (2011). Self-efficacy buffers the relationship between dementia caregiving stress and circulating concentrations of the proinflammatory cytokine interleukin-6. The American Journal of Geriatric Psychiatry, 19(1), 64-71. https://doi.org/10.1097/JGP.0b013e3181df4498
  • McNaughton, M. E., Patterson, T. L., Smith, T. L., & Grant, I. (1995). The relationship among stress, depression, locus of control, irrational beliefs, social support, and health in Alzheimer’s disease caregivers. Journal of Nervous Mental Disease, 183(2), 78-85. https://doi. org/10.1097/00005053-199502000-00003
  • Montorio, I., Losada, A., Izal, M., & Márquez, M. (2009). Dysfunctional Thoughts about Caregiving Questionnaire: Psychometric properties of a new measure. International Psychogeriatrics, 21(5), 913-921. https://doi. org/10.1017/S1041610209990366
  • Moore, R. C., Chattillion, E. A., Ceglowski, J., Ho, J., von Känel, R., Mills, P. J., Ziegler, M. G., Patterson, T. L., Grant, I., & Mausbach, B. T. (2013). A randomized clinical trial of behavioral activation (BA) therapy for improving psychological and physical health in dementia caregivers: Results of the Pleasant Events Program (PEP). Behaviour Research and Therapy, 51(10), 623-632. https://doi.org/10.1016/j.brat.2013.07.005
  • Ottaviani, C., Thayer, J.F., Verkuil, B., Lonigro, A., Medea, B., Couyoumdjian, A., & Brosschot, J. F. (2016). Physiological concomitants of perseverative cognition: A systematic review and meta-analysis. Psychological Bulletin, 142(3), 231.-259 https://doi.org/10.1037/bul0000036
  • Pinquart, M., & Sörensen, S. (2007). Correlates of physical health of informal caregivers: a meta-analysis. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 62(2), P126-P137. https://doi. org/10.1093/geronb/62.2.P126
  • Preacher, K. J., & Hayes, A. F. (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, Instruments, and Computers, 36, 717-731. https://doi.org/10.3758/ BF03206553
  • Rapsomaniki, E., Timmis, A., George, J., Pujades-Rodriguez, M., Shah, A.D., Denaxas, S., White, I. R., Caulfiel, M. J., Deanfield, J. E., Smeeth, L., Williams,
  • https://journals.copmadrid.org/clysa/archivos/cl2009v20n1a7.pdf
  • https://journals.copmadrid.org/clysa/archivos/cl2009v20n1a7.pdf
  • https://doi.org/10.1348/135910710X504932
  • https://doi.org/10.1348/135910710X504932
  • https://doi.org/10.1111/j.1751-9004.2012.00448.
  • https://doi.org/10.1111/j.1751-9004.2012.00448.
  • https://doi.org/10.1016/S0006-3223(02)01926-1
  • https://doi.org/10.1016/S0006-3223(02)01926-1
  • https://doi.org/10.1017/S1041610218000947
  • https://doi.org/10.1017/S1041610218000947
  • https://doi.org/10.1177/0733464817705958
  • https://doi.org/10.1177/0733464817705958
  • https://doi.org/10.1080/13607863.2014.896868
  • https://doi.org/10.1080/13607863.2014.896868
  • http://doi.org/10.1016/j.clysa.2015.02.001
  • http://doi.org/10.1016/j.clysa.2015.02.001
  • https://www.behavioralpsycho.com/wp-content/uploads/2020/04/08.Losada_14-1oa-1.pdf
  • http://doi.org/10.1080/13607863.2017.1293003
  • http://doi.org/10.1080/13607863.2017.1293003
  • https://doi.org/10.1097/01.JGP.0000192492.88920.08
  • https://doi.org/10.1097/01.JGP.0000192492.88920.08
  • https://doi.org/10.1037/a0027783
  • https://doi.org/10.1037/a0027783
  • http://doi.org/10.1037/0278-6133.26.5.539
  • http://doi.org/10.1037/0278-6133.26.5.539
  • https://doi.org/10.1097/00005053-199502000-00003
  • https://doi.org/10.1097/00005053-199502000-00003
  • https://doi.org/10.1017/S1041610209990366
  • https://doi.org/10.1017/S1041610209990366
  • https://doi.org/10.1093/geronb/62.2.P126
  • https://doi.org/10.1093/geronb/62.2.P126
  • https://doi.org/10.3758/BF03206553
  • https://doi.org/10.3758/BF03206553
  • B., Hingorani, A., & Hemingway, H. (2014). Blood pressure and incidence of twelve cardiovascular diseases: Lifetime risks, healthy life-years lost, and age-specific associations in 1.25 million people. Lancet, 383(9932), 1899-1911. http://doi.org/10.1016/S0140-6736(14)60685-1
  • Roepke, S. K., Mausbach, B. T., Patterson, T. L., Von Känel, R., Ancoli-Israel, S., Harmell, A. L., Dimsdale, J. E., Aschbacher, K., Mills, P. J., Ziegler, M. G., Allison, M., & Grant, I. (2011). Effects of Alzheimer caregiving on allostatic load. Journal of Health Psychology, 16(1), 58-69. https://doi. org/10.1177/1359105310369188
  • Schulz, R., & Sherwood, P. R. (2008). Physical and mental health effects of family caregiving. Journal of Social Work Education, 44(Suppl 3), 105- 113. https://doi.org/10.5175/JSWE.2008.773247702
  • Shaw, W. S., Patterson, T. L., Ziegler, M. G., Dimsdale, J. E., Semple, S. J., & Grant, I. (1999). Accelerated risk of hypertensive blood pressure recordings among Alzheimer caregivers. Journal of Psychosomatic Research, 46(3), 215-227. http://doi.org/10.1016/S0022-3999(98)00084-1
  • Sinha, R., Lovallo, W. R., & Parsons, O. A. (1992). Cardiovascular differentiation of emotions. Psychosomatic Medicine, 54(4), 422-435. https://doi.org/10.1097/00006842-199207000-00005
  • Spira, A. P., Beaudreau, S. A., Jimenez, D., Kierod, K., Cusing, M. M., Gray, H. L., & Gallagher-Thompson, D. (2007). Experiential avoidance, acceptance, and depression in dementia family caregivers. Clinical Gerontologist, 30(4), 55-64. https://doi.org/10.1300/J018v30n04_04
  • Stall N. M., Kim S. J., Hardacre K. A., Shah P. S., Straus S. E., Bronskill S. E., Lix, L. M., Bell, C. M., & Rochon, P. A. (2019). Association of informal caregiver distress with health outcomes of community-dwelling dementia care recipients: A systematic review. Journal of the American Geriatric Society, 67(3), 609-617. https://doi.org/10.1111/jgs.15690
  • Stebbins, P., & Pakenham, K. I. (2001). Irrational schematic beliefs and psychological distress in caregivers of people with traumatic brain injury. Rehabilitation Psychology, 46(2), 178-194. https://doi. org/10.1037/0090-5550.46.2.178
  • Tabachnick B., & Fidell, L. (2001). Using multivariate statistics (4th ed.). Allyn & Bacon.
  • Vara-García, C., Romero-Moreno, R., Márquez-González, M., Mausbach, B. T., von Känel, R., Gallego-Alberto, L., Olmos, R., & Losada, A. (2019). Stress and blood pressure in dementia caregivers: The moderator role of mindfulness. Clinical gerontologist, 42(5), 512-520. https://doi.org/ 10.1080/07317115.2018.1554611
  • Vázquez-Sánchez, M. Á., Aguilar-Trujillo, M. P., Estébanez-Carvajal, F. M., Casals-Vázquez, C., Casals-Sánchez, J. L., & Heras-Pérez, M. C. (2012). Influencia de los pensamientos disfuncionales en la sobrecarga de los cuidadores de personas dependientes. Enfermería Clínica, 22(1), 11-17. https://doi.org/10.1016/j.enfcli.2011.07.002
  • Vitaliano, P. P., Russo, J., Bailey, S., Young, H., & McCann, B. (1993). Psychosocial factors associated with cardiovascular reactivity in older individuals. Psychosomatic Medicine, 55, 164-177
  • Vitaliano, P. P., Scanlan, J. M., Zhang, J., Savage, M. V., Hirsch, I. B., & Siegler, I. C. (2002). A path model of chronic stress, the metabolic syndrome, and coronary heart disease. Psychosomatic Medicine, 64(3), 418-435. https://doi.org/10.1097/00006842-200205000-00006
  • Vitaliano, P. P., Zhang, J., & Scanlan, J. M. (2003). Is caregiving hazardous to one’s physical health? A meta-analysis. Psychological Bulletin, 129(6), 946-972. http://doi.org/10.1037/0033-2909.129.6.946
  • Vitaliano, P. P., Young, H. M., & Zhang, J. (2004). Is caregiving a risk factor for illness? Current Directions in Psychological Science, 13(1), 13-16. https://doi.org/10.1111/j.0963-7214.2004.01301004.x
  • von Känel, R., & Albus, C. (2018). Psychological factors and health disease mechanisms: Psychological factors and outcomes. In A. J. Camm, T. F. Lüscher, G. Maurer, & P. W. Serruys (Eds.). The ESC textbook of cardiovascular medicine (3rd ed.). Oxford University Press.
  • von Känel, R., Mausbach, B. T., Dimsdale, J. E., Mills, P. J., Patterson, T. L., Ancoli-Israel, S., Ziegler, M. G., Roepke, S. K., Harmell, A. L., Allison, M., & Grant, I. (2011). Regular physical activity moderates cardiometabolic risk in Alzheimer’s caregivers. Medicine and Science in Sports and Exercise, 43(1), 181-189. https://doi.org/10.1249/ MSS.0b013e3181e6d478
  • von Känel, R., Mausbach, B. T., Patterson, T. L., Dimsdale, J. E., Aschbacher, K., Mills, P. J., Ziegler, M. G., Ancoli-Israel, S., & Grant, I. (2008). Increased Framingham coronary heart disease risk score in dementia caregivers relative to non-caregiving controls. Gerontology, 54, 131-137. https:// doi.org/10.1159/000113649
  • Werner, P. (2001). Correlates of family caregivers’ knowledge about Alzheimer’s disease. International Journal of Geriatric Psychiatry, 16(1), 32-38.https://doi.org/10.1002/1099-1166(200101)16:1<32::AIDGPS268>3.0.CO;2-2
  • http://doi.org/10.1016/S0140-6736(14)60685-1
  • https://doi.org/10.1177/1359105310369188
  • https://doi.org/10.1177/1359105310369188
  • http://doi.org/10.1016/S0022-3999(98)00084-1
  • https://doi.org/10.1037/0090-5550.46.2.178
  • https://doi.org/10.1037/0090-5550.46.2.178
  • https://doi.org/10.1080/07317115.2018.1554611
  • https://doi.org/10.1080/07317115.2018.1554611
  • https://doi.org/10.1080/07317115.2018.1554611
  • https://doi.org/10.1249/MSS.0b013e3181e6d478
  • https://doi.org/10.1249/MSS.0b013e3181e6d478
  • https://doi.org/10.1002/1099-1166(200101)16:1<32::AID-GPS268>3.0.CO;2-2
  • https://doi.org/10.1002/1099-1166(200101)16:1<32::AID-GPS268>3.0.CO;2-2
Fuente de los datos: Dialnet