There is limited evidence on caregiver outcomes associated with mild cognitive impairment in patients with Parkinson’s disease (PD-MCI) and the coping strategies used by these caregivers. To investigate this relationship, we examined levels of burden, depression, anxiety, coping strategies and positive aspects of caregiving in the informal caregivers of 96 PD patients. The PD patients were classified using MDS-Task Force Level II criteria as showing either normal cognition (PD-N; n = 51), PD-MCI (n = 30) or with dementia (PDD; n = 15). Mean Zarit Burden Interview (ZBI) score increased significantly between carers of PD-N (M = 13.39, SD = 12.22) compared to those of PD-MCI patients (M = 22.00, SD = 10.8), and between carers of PD-MCI and PDD patients (M = 29.33, SD = 9.59). Moreover, the proportion of carers showing clinically significant levels of burden (ZBI score ≥ 21) also increased as the patients’ cognitive status declined (18% for PD-N; 60% for PD-MCI; and 80% for PDD) and was mirrored by an increasing amount of time spent providing care by the caregivers. Caregiver ZBI score was independent of patient neuropsychiatric symptoms, motor function, disease duration and time that caregivers spent caregiving. Caregiver use of different coping strategies increased with worsening cognition. However, we found only equivocal evidence that the use of problem-focused, emotion-focused and dysfunctional coping mediated the association between patient cognitive status and caregiver burden, because the inverse models that used caregiver burden as the mediator were also significant. The study highlights the impact of Parkinson’s disease on those providing care when the patient’s cognition is poor, including those with MCI. Caregiver well-being has important implications for caregiver support, nursing home placement and disease course.
The increase in obesity and the many educational messages prompting us to eat a healthy diet have heightened people’s concerns about the effects of food choice on health and weight. An unintended side effect may be that such awareness fuels feelings of guilt and worry about food. Although guilt has the potential to motivate behaviour change, it may also lead to feelings of helplessness and loss of control. The current study examined the relationship between a default association of either ‘guilt’ or ‘celebration’ with a prototypical forbidden food item (chocolate cake), indicators of healthy eating and choosing food for mood regulation reasons. Following a ‘diathesis-stress’ perspective, the moderating roles of depressive symptoms and stress were examined. Although a default association of guilt was found to be harmless under some circumstances (i.e. under low stress), those who associated chocolate cake with guilt (vs. celebration) reported unhealthier eating habits and lower levels of perceived behavioural control over healthy eating when under stress, rated mood regulation reasons for food choice as important irrespective of their current affective state, and did not have more positive attitudes towards healthy eating. Implications for public health messages and interventions will be discussed.