https://hdl.handle.net/20.500.12450/1684 PubMed Indexed Publications Collection 2026-04-07T10:10:02Z https://hdl.handle.net/20.500.12450/6166 Mechanisms Underlying the Use of Abusive and Neglectful Behaviors in Dementia Caregiving The Role of Caregiver Mental Health Browning, Wesley R.; Yildiz, Mustafa; Chilatra, Jessica A. Hernandez; Yefimova, Maria; Maxwell, Christopher D.; Sullivan, Tami P.; Winstead, Vicki PURPOSE: In dementia family caregiving, caregiver psychopathology has been frequently identified as a possible risk factor for the use of physically abusive, psychologically abusive, and neglectful behaviors toward care recipients. Yet, the mechanistic role of psychopathology in the use of these behaviors is not understood. The purpose of the current study is to determine the role of caregiver mental health in their daily risk of engaging in physically and psychologically aggressive and neglectful behaviors toward their care recipient with dementia. METHOD: We used an intensive longitudinal design to survey family caregivers daily over 21 days. Using generalized linear mixed models, we evaluated the differential impact of caregivers'(N = 453) experience of major depression and generalized anxiety disorders measured at baseline versus 9,513 daily ratings of depressive and anxiety symptom severity, and interactions across levels, on the daily odds of engaging in physically abusive, psychologically abusive, and neglectful behaviors. RESULTS: Caregivers with clinically significant depression or anxiety at baseline had higher daily odds of engaging in each type of abusive and neglectful behavior. Worsened depressive symptoms (compared to individuals'average across all days) on a given day were associated with increased odds of engaging in psychologically and physically aggressive behaviors on the same day. Worsened anxiety symptoms on a given day were associated with increased odds of psychologically aggressive and neglectful behaviors. CONCLUSION: A key finding was lack of a significant interaction effect between depression and anxiety disorders and mental health symptomology on the daily odds of engaging in abusive and neglectful behaviors. This finding indicates that daily depressive and anxiety symptoms are generalizable intervention targets across the family caregiver population and do not only increase risk among family caregivers with depressive and anxiety disorders. [ Research in Gerontological Nursing, 17 (5), 227-236.] 2024-01-01T00:00:00Z https://hdl.handle.net/20.500.12450/6155 Subsyndromes and symptom clusters: Multilevel factor analysis of behavioral and psychological symptoms of dementia with intensive longitudinal data Pickering, Carolyn E. Z.; Winstead, Vicki; Yildiz, Mustafa; Wang, Danny; Yefimova, Maria; Pickering, Andrew M. INTRODUCTIONBehavioral and psychological symptoms in dementia (BPSD) are dynamic phenomena with a high amount of intraindividual variability. We applied a multilevel framework to identify subsyndromes (between-person factors) that represent clinically relevant profiles of BPSD and identify symptom clusters (within-person factors) that represent contextually driven daily symptom experiences.METHODSThis study used an intensive longitudinal design in which 68 co-residing family caregivers to persons living with dementia were recruited to proxy report on their care recipient's daily symptom experiences of 23 different BPSD for eight consecutive days (n = 443 diaries). A multilevel exploratory/confirmatory factor analysis was used to account for nested data and separate within-person variances from between-level factor estimates.RESULTSExploratory factor analysis identified a 4-between 3-within factor structure based on fit statistics and clinical interpretability.DISCUSSIONThis study offers major methodological and conceptual advancements for management of BPSD within Alzheimer's disease and related dementias by introducing two related but distinct concepts of subsyndromes and symptom clusters.Highlights Because behavioral and psychological symptoms of dementia (BPSD) are dynamic temporal phenomenon, this introduces measurement error into aggregate group-level estimates when trying to create subsyndromes. We propose a multilevel analysis to provide a more valid and reliable estimation by separating out variance due to within-person daily fluctuations. Using a multilevel exploratory factor analysis with intensive longitudinal data, we identified distinct and meaningful groups of BPSD. The four factors at the between-person level represented subsyndromes that are based on how BPSD co-occurred among persons with Alzheimer's disease (AD). These subsyndromes are clinically relevant because they share features of established clinical phenomena and may have similar neurobiological etiologies. We also found three within-person factors representing distinct symptom clusters. They are based on how BPSD clustered together on a given day for an individual with AD and related dementias. These clusters may have shared environmental triggers. 2024-01-01T00:00:00Z https://hdl.handle.net/20.500.12450/6151 Association between Breast Arterial Calcification on Mammography and Impaired Ocular Perfusion Akman, Burcu; Kaya, Ahmet Turan Objectives - To investigate the relationship between the mammography-detected breast arterial calcification (BAC) and orbital color Doppler ultrasonography (CDUS) results. Methods - Our single-center study, included female patients who applied to our hospital between January and May 2022 and underwent mammography and orbital CDUS examinations. Two radiologists evaluated the mammograms, grouped the patients as BAC (+) and BAC (-), and performed orbital CDUS. Continuous variables obtained from CDUS were compared according to the presence of BAC. Also, receiver operating characteristics (ROC) analysis was used to determine the orbital CDUS threshold values for the presence of BAC. Results - A total of 119 women were included with a median age of 62 years, 57 (47.90%) had BAC. Orbital CDUS examination was performed on both eyes of 119 patients (238 eyes in total). Peak systolic velocity (PSV) and end-diastolic velocity (EDV) values of the ophthalmic artery (OA) (P < .001) and EDV of the central retinal artery (CRA) (P < .001) were significantly lower in patients with BAC. Pulsatile index (PI) and resistive index (RI) values of OA (P < .001) and CRA (P < .001) were higher in patients with BAC. In ROC analysis, the cut-off values for the presence of BAC were calculated as OA PI >= 1.415 and OA RI >= 0.755 (P < .001); CRA PI >= 1.135 and CRA RI >= 0.655 (P < .001). Conclusions - Orbital perfusion disorders may be observed in patients with vascular calcification detected on routine mammography. Therefore, a more detailed evaluation of patients with BAC detected on mammography with orbital CDUS may enable early detection and treatment of ocular vascular problems. 2025-01-01T00:00:00Z https://hdl.handle.net/20.500.12450/6153 How and why to follow best practices for testing mediation models with missing data Schoemann, Alexander M.; Moore, E. Whitney G.; Yagiz, Gokhan Mediation models are often conducted in psychology to understand mechanisms and processes of change. However, current best practices for handling missing data in mediation models are not always used by researchers. Missing data methods, such as full information maximum likelihood (FIML) and multiple imputation (MI), are best practice methods of handling missing data. However, FIML or MI are rarely used to handle missing data when testing mediation models, instead analyses used listwise deletion methods, the default in popular software. Compared to listwise deletion, the implementation of FIML or MI to handle missing data reduces parameter estimate bias, while maintaining the sample collected to maximise power and generalizability of results. In this tutorial, we review how to implement full-information maximum likelihood and MI using best practice methods of testing the indirect effect. We demonstrate how to implement these methods using both R and JASP, which are both free, open-source software programmes and provide online supplemental materials for these demonstrations. These methods are demonstrated using two example analyses, one using a cross-sectional mediation model and one using a longitudinal mediation model examining how student-athletes reported worry about COVID predicts their perceived stress, which in turn predicts satisfaction with life. 2024-01-01T00:00:00Z