Development of an integrated family assessment inventory based on the Double ABCX and Circumplex models of family functioning and its clinical utility was evaluated with 121 primary family caregivers from a cognitive disorders program. The proposed model predicted a significant proportion of the variance associated with caregiver stress and strain. Several aspects of the caregiving arrangement also emerged as key features in predicting caregiver depression. These findings supported the model's central premise that both dyadic (caregiver-patient) and systemic (caregiver-family) variables are salient in assessing the impact of family caregiving with dementia.

A model of spousal caregiving was constructed in which current marital functioning was hypothesized to predict caregiver depression independent of the patient's clinical status and caregiver characteristics including burden. The sample was comprised of 96 consecutive marital dyads seeking evaluation at a university-based cognitive disorders program. The results of path analysis supported a model in which current marital functioning was significantly and independently associated with the caregiver's mental health. Specifically, spouse caregivers reporting low marital cohesion and satisfaction endorsed significantly more depressive symptoms. These findings supported the model's central premise that relational losses are discretely related to the mental health of spouse caregivers and warrant consideration in the assessment and care of spouse caregivers.

Although several scales have been developed to assess burden, their clinical utility has been limited by the absence of relevant cutoff points. Clinical data from 140 primary caregivers seeking a dementia evaluation for a family member were analyzed to establish the psychometric properties of a caregiver burden screen. Results indicate that the cutoff values were both sensitive and specific to negative caregiving outcomes. These findings suggest that use of a burden screen may assist clinicians when assessing the adequacy of caregiving arrangements in dementia.

Expansion of the world's elderly populations has increased concerns about aging-related medical disorders like Alzheimer's disease and other dementias. In the United States, one fourth of those older than age 65 and at greatest risk for developing dementia live in rural environments that may influence its manifestation. The objectives of this study were to determine the need for and potential benefits of further epidemiological research concerning dementia and similar disorders in rural U.S. populations and to identify pertinent methodological issues related to rural dementia research. This study employed a National Library of Medicine (MEDLINE) document search based on the key words "cognitive disorders," "dementia," "Alzheimer's disease," and "rural," followed by recovery of literature resources references in the bibliographies of selected articles. Nineteen studies focusing on dementia or related disorders in rural settings have been reported from around the world. While four of these were conducted in the United States, only one rural dementia prevalence study has been undertaken in this country. Because of methodological variability, comparisons of prevalence estimates between these rural studies, as well as with those from urban investigations, is difficult. Nonetheless, there is reason to believe that certain potentially dementing illnesses are more common in rural populations. There is also evidence to suggest that the screening instruments commonly used in such studies tend to misclassify rural elders as "false positive" dementia cases. Information regarding dementing disorders, particularly Alzheimer's disease, in rural populations is scarce. Preliminary observations that dementia may be more common in rural settings and that rural families are more likely to maintain their dementing elders in the community imply that further rural dementia research could yield important insights into the risk factors for these illnesses, the variables influencing their course, and the methods by which they can be more effectively managed. A determination of the reliability and validity of commonly used dementia screening instruments in rural populations would represent an important advancement in this area of research.

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