Publications

Family caregivers of persons living with dementia face persistent caregiving demands that heighten risk for anxiety, depressive symptoms, and perceived stress. Although caregiving distress is well documented, less is known about the cognitive processes that link anxiety to broader psychological distress, or whether mindfulness-based interventions change these processes. This study examined rumination as a cognitive mediator linking anxiety with psychological distress and tested whether mindfulness training moderated this association.

Using data from a randomized controlled trial comparing the Practice of Awareness, Acceptance, and Compassion in Caregiving (PAACC) program with REACH-VA, we conducted a pre-planned secondary mechanistic analysis using structural equation models (N = 133). Models tested whether post-intervention rumination mediated associations between post-intervention anxiety and depressive symptoms, perceived stress, and caregiver burden, while adjusting for baseline variables, and whether the anxiety-rumination association differed by intervention group.

Rumination significantly mediated associations between anxiety and both depressive symptoms and perceived stress, but not caregiver burden. The anxiety-rumination association was stronger among PAACC participants, with conditional indirect effects only in this group. No direct group differences in post-intervention outcomes emerged. The findings highlight rumination as an important cognitive process linking anxiety with psychological distress and suggest that mindfulness training may influence how anxiety is cognitively elaborated, rather than uniformly reducing distress. Future research in diverse caregiver populations and with longer timeframes is warranted to clarify temporal ordering and the variability in responsiveness to mindfulness-based approaches.

More than 11 million Americans provide unpaid care to someone with dementia, and nearly half report clinically significant anxiety. Yet most caregiver support programs focus on depression and burden — anxiety is largely overlooked. Our study asked what happens when caregivers can't stop worrying, and whether a brief mindfulness program can interrupt that process before it spirals into deeper distress.

The study was a randomized controlled trial conducted at the Salem VA Health Care System and compared two structured caregiver programs, one of which embedded short mindfulness practices into routine dementia education and behavioral management. The findings are both promising and nuanced. Caregivers who ruminate — who repeatedly replay worries, guilt, and worst-case scenarios — are more likely to develop depression and feel overwhelmed. Mindfulness training appeared to alter that link, but primarily for caregivers who received it before their anxiety became severe. For those already in significant distress, brief mindfulness practices alone may not be enough. That finding has direct clinical implications: it points to the importance of reaching caregivers earlier, before the emotional toll becomes entrenched.

Although inattention symptoms have been previously linked to cognitive performance in younger samples, few studies have examined links between ADHD symptoms and cognitive performance for middle aged and older adults. In this study, we drew from a nationally representative sample from the Health and Retirement Study (HRS) of ~1400 middle to older adults (Mage = 66.9, SD = 8.4; 41.4% male; 60.7% White) who completed a set of cognitive measures and an ADHD symptomatology questionnaire in the 2016 Wave. A multigroup path model was run by examining the association between self-reported ADHD symptom subscale scores for inattention and hyperactivity/impulsivity as well as self-reported depressive symptoms and cognitive outcomes across 3 groups: middle age, young-old, middle-old. Inattention symptoms were significantly associated with Serial 7s and Immediate Recall, however the constrained model was the best fitting model, suggesting no differences in the associations between self-reported inattention symptoms and cognitive outcomes by age. These results are consistent with previous work on the links between ADHD symptoms and cognitive performance in younger populations and add to the literature on ADHD in later life. This may have implications for clinicians and practitioners as well as future research on older adults with ADHD.

In this study, we analyzed data from about 1,400 people in the United States whose ages ranged from 55 to 84 years (average age 67 years) and who completed cognitive tests as well as a questionnaire about ADHD symptoms. We looked at three age groups (50-64 years, 65-74 years, and 75-84 years) to see if the relationship between self-reported ADHD symptoms and cognitive performance was more linked to inattentive symptoms or hyperactive impulsive symptoms. We also wanted to see if the links between self-reported ADHD symptoms and cognition changed with age. We found that people who reported more problems with attention also scored lower on two cognitive tasks (subtracting seven backwards from hundred and recalling a list of words immediately). Interestingly, this pattern held steady across all age groups i.e., the connection between attention difficulties and these skills didn't seem to get stronger or weaker with age. We also didn't find any links between self-reported ADHD symptoms and depressive symptoms. These findings match what researchers have already observed in younger people and add new information about ADHD in later life. The results could be useful for doctors working with older patients and may guide future research on aging adults with ADHD. 

Although recent research has consistently shown that psychological resilience is positively associated with cognitive function among older adults, the underlying mechanisms are still largely unclear. In this study, we assessed the potential mediating role of physical activity between psychological resilience and cognition using a longitudinal, population dataset of US older adults. Data were derived from three time points (2010-2012, 2014-2016, and 2018-2020) of the Health and Retirement Study (HRS), with 8,296 older adults at baseline included (aged 65 or above). Cognitive function was measured by 35-point Telephone Interview Cognitive Screen (TICS). psychological resilience was measured using a previously established simplified resilience score. Psychological resilience at baseline was positively associated with physical activity at T2, 4 years later (β=0.08,SE=0.01,p<0.001). In addition, physical activity predicted an increase in cognitive function from T2 to T3 (4 years to 8 years later) (β=0.05,SE=0.07,p<0.001). Finally, a significant indirect effect of psychological resilience (T1) on cognitive function (T3) through physical activity from (T2) was observed (β = 0.01, 95% CI [0.01, 0.02], p <0.001). Physical activity may function as a protective factor for the cognitive functioning of older adults. This association is partially mediated by enhanced physical activity.

In this study, we looked at whether physical activity might explain the connection between psychological resilience and better cognition using data from over 8,000 Americans aged 65 and older, tracking them for 8 years. We measured their resilience, exercise habits, and cognitive performance at three time points (2010-2012, 2014-2016, and 2018-2020). The results revealed an interesting chain of events: older adults who showed greater resilience were more physically active four years later. In turn, those who were more active maintained cognitive skills over the following four years. Statistical analysis confirmed that physical activity served as a key link between resilience and cognitive health. These findings suggest that staying physically active may be one important way that resilience protects brain function as we age. The results highlight the value of both building psychological resilience and maintaining regular physical activity for preserving mental sharpness in later life.

Understanding the association between polygenic risk for ADHD and cognition throughout aging has not been widely studied. This study aimed to determine whether ADHD risk influences cognitive performance among individuals at both young-old and middle-old age. Participants from the Health and Retirement Study, a biennial survey of 20,000 Americans, were compared on executive function and delayed recall measures using regression analyses. There was no significant effect of ADHD risk on memory at both age waves for African-ancestry (AA; n = 403) and European-ancestry (EA; n = 2,286). There was, however, a significant association between ADHD risk and performance on executive function for EA at middle-old age (p = .028), but not young-old age; no such association was observed for AA adults. This finding suggests that ADHD risk may differentially influence cognition among older adults throughout the aging process, with important implications for future research.

In this study we examined whether inherited ADHD risk influences mental performance in older adults at different life stages. We analyzed data from over 2,600 older Americans, comparing their performance on memory tests and executive function tasks (skills like planning and problem-solving). Participants were divided by age group (younger-old vs. middle-old) and ancestry (African or European). The genetic tendency to have ADHD didn't affect memory performance in any group. However, among European-ancestry adults in the older age bracket, higher genetic risk for ADHD was linked to lower executive function scores. This pattern wasn't seen in younger-old adults or in African-ancestry participants. These findings suggest that genetic vulnerability to ADHD may influence cognition differently as people age and may vary across populations. Understanding these patterns could help researchers better predict and address cognitive changes in older adults with ADHD risk factors.