Advertisement

The role of dispositional mindfulness in a stress-health pathway among Parkinson’s disease patients and caregiving partners

  • Allison Hicks
  • Kala Phillips
  • Chelsea Siwik
  • Paul Salmon
  • Irene Litvan
  • Megan E. Jablonski
  • J. Vincent Filoteo
  • Karen Kayser
  • Sandra E. SephtonEmail author
Article

Abstract

Purpose

Parkinson’s disease (PD) patients and their caregivers experience significant distress that impacts physical, emotional and social functioning in the patient, and in turn, has a significant impact on the caregiver. Lower levels of stress have been associated with a better prognosis in PD. The quality of dispositional mindfulness—innate present moment, non-judgmental awareness—has consistently been associated with less perceived stress, greater well-being, and better physical health in both clinical and healthy populations. To date, associations of mindfulness with distress, depression, sleep problems, and other variables that define health-related quality of life have not been examined in the context of PD patient/caregiver dyads.

Methods

We investigated the impact of dispositional mindfulness in a stress-health model among eighteen dyads consisting of PD patients and their caregivers.

Results

Multilevel linear modeling (actor–partner interdependence models) revealed significant associations between dispositional mindfulness and stress appraisal, interpersonal support, depressive symptoms, sleep, and health-related quality of life (HRQOL) within both dyadic partners. As expected, results demonstrated significant associations of distress with interpersonal support, depressive symptoms, sleep and HRQOL for both PD patients and caregivers.

Conclusions

Dispositional mindfulness was associated with reduced distress and its downstream clinical consequences. These results support an ameliorative role for dispositional mindfulness among PD patients and caregivers, as a protective factor against psychosocial burdens imposed on couples related to disease and caregiving. Findings suggest future studies should explore mindfulness training as a therapeutic option.

Keywords

Mindfulness Parkinson’s disease Quality of life Caregiver 

Notes

Funding

This study was funded through an Intramural Research Incentive Grants: Multidisciplinary Research Grant from the Office of the Executive Vice President for Research and Innovation at the University of Louisville

Compliance with ethical standards

Conflict of interest

The authors declare they have no conflict of interest.

References

  1. 1.
    Fahn, S., & Przedborski, S. (2000). Parkinsonism. Merritt’s Neurology, 1, 679–693.Google Scholar
  2. 2.
    Rossi, A., Berger, K., Chen, H., Leslie, D., Mailman, R. B., & Huang, X. (2018). Projection of the prevalence of Parkinson’s disease in the coming decades: Revisited. Movement Disorders, 33(1), 156–159.Google Scholar
  3. 3.
    Witjas, T., Kaphan, E., Azulay, J., Blin, O., Ceccaldi, M., Pouget, J., et al. (2002). Nonmotor fluctuations in Parkinson’s disease frequent and disabling. Neurology, 59(3), 408–413.Google Scholar
  4. 4.
    Schapira, A. H., Chaudhuri, K. R., & Jenner, P. (2017). Non-motor features of Parkinson disease. Nature Reviews Neuroscience, 18(7), 435.Google Scholar
  5. 5.
    Chaudhuri, K. R., Healy, D. G., & Schapira, A. H. (2006). Non-motor symptoms of Parkinson’s disease: Diagnosis and management. The Lancet Neurology, 5(3), 235–245.Google Scholar
  6. 6.
    Reijnders, J. S., Ehrt, U., Weber, W. E., Aarsland, D., & Leentjens, A. F. (2008). A systematic review of prevalence studies of depression in Parkinson’s disease. Movement Disorders, 23(2), 183–189.Google Scholar
  7. 7.
    Weintraub, D., & Claassen, D. O. (2017). Impulse control and related disorders in Parkinson’s disease. International review of neurobiology (Vol. 133, pp. 679–717). New York: Elsevier.Google Scholar
  8. 8.
    Salmon, P. G., Sephton, S. E., & Dreeben, S. J. (2011). Mindfulness-Based Stress Reduction. In J. D. Herbert & E. M. Forman (Eds.), Acceptance and mindfulness in cognitive behavior therapy (pp. 132–163). Hoboken, NJ USA: Wiley.Google Scholar
  9. 9.
    Lazarus, R. S., & Folkman, S. (1987). Transactional theory and research on emotions and coping. European Journal of Personality, 1(3), 141–169.Google Scholar
  10. 10.
    Macht, M., Schwarz, R., & Ellgring, H. (2005). Patterns of psychological problems in Parkinson’s disease. Acta Neurologica Scandinavica, 111(2), 95–101.Google Scholar
  11. 11.
    Habermann, B. (1996). Day-to-day demands of Parkinson’s disease. Western Journal of Nursing Research, 18(4), 397–413.Google Scholar
  12. 12.
    Dexter, D. T., & Jenner, P. (2013). Parkinson disease: From pathology to molecular disease mechanisms. Free Radical Biology & Medicine, 62, 132–144.Google Scholar
  13. 13.
    Peto, V., Jenkinson, C., Fitzpatrick, R., & Greenhall, R. (1995). The development and validation of a short measure of functioning and well being for individuals with Parkinson’s disease. Quality of Life Research, 4(3), 241–248.Google Scholar
  14. 14.
    Brod, M., Mendelsohn, G. A., & Roberts, B. (1998). Patients’ experiences of Parkinson’s disease. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 53(4), P213–P222.Google Scholar
  15. 15.
    Karlsen, K. H., Larsen, J. P., Tandberg, E., & Mæland, J. G. (1999). Influence of clinical and demographic variables on quality of life in patients with Parkinson’s disease. Journal of Neurology, Neurosurgery and Psychiatry, 66(4), 431–435.Google Scholar
  16. 16.
    Aarsland, D., Brønnick, K., Ehrt, U., De Deyn, P. P., Tekin, S., Emre, M., et al. (2007). Neuropsychiatric symptoms in patients with Parkinson’s disease and dementia: Frequency, profile and associated care giver stress. Journal of Neurology, Neurosurgery and Psychiatry, 78(1), 36–42.Google Scholar
  17. 17.
    Yang, S., Sajatovic, M., & Walter, B. L. (2012). Psychosocial interventions for depression and anxiety in Parkinson’s disease. Journal of Geriatric Psychiatry and Neurology, 25(2), 113–121.Google Scholar
  18. 18.
    Remy, P., Doder, M., Lees, A., Turjanski, N., & Brooks, D. (2005). Depression in Parkinson’s disease: Loss of dopamine and noradrenaline innervation in the limbic system. Brain, 128(6), 1314–1322.Google Scholar
  19. 19.
    Schrag, A., Jahanshahi, M., & Quinn, N. (2000). What contributes to quality of life in patients with Parkinson’s disease? Journal of Neurology, Neurosurgery and Psychiatry, 69(3), 308–312.Google Scholar
  20. 20.
    Smith, M. C., Ellgring, H., & Oertel, W. H. (1997). Sleep disturbances in Parkinson’s disease patients and spouses. Journal of the American Geriatrics Society, 45(2), 194–199.Google Scholar
  21. 21.
    Lees, A. J., Blackburn, N. A., & Campbell, V. L. (1988). The nighttime problems of Parkinson’s disease. Clinical Neuropharmacology, 11(6), 512–519.Google Scholar
  22. 22.
    Askenasy, J. (1993). Sleep in Parkinson’s disease. Acta Neurologica Scandinavica, 87(3), 167–170.Google Scholar
  23. 23.
    Chokroverty, S. (1996). Sleep and degenerative neurologic disorders. Neurologic Clinics, 14(4), 807–826.Google Scholar
  24. 24.
    Tandberg, E., Larsen, J. P., & Karlsen, K. (1998). A community-based study of sleep disorders in patients with Parkinson’s disease. Movement Disorders: Official Journal of the Movement Disorder Society, 13(6), 895–899.Google Scholar
  25. 25.
    Skorvanek, M., Nagyova, I., Rosenberger, J., Krokavcova, M., Saeedian, R. G., Groothoff, J. W., et al. (2013). Clinical determinants of primary and secondary fatigue in patients with Parkinson’s disease. Journal of Neurology, 260(6), 1554–1561.Google Scholar
  26. 26.
    Barone, P., Antonini, A., Colosimo, C., Marconi, R., Morgante, L., Avarello, T. P., et al. (2009). The PRIAMO study: A multicenter assessment of nonmotor symptoms and their impact on quality of life in Parkinson’s disease. Movement Disorders: Official Journal of the Movement Disorder Society, 24(11), 1641–1649.Google Scholar
  27. 27.
    Antonini, A., Barone, P., Marconi, R., Morgante, L., Zappulla, S., Pontieri, F. E., et al. (2012). The progression of non-motor symptoms in Parkinson’s disease and their contribution to motor disability and quality of life. Journal of Neurology, 259(12), 2621–2631.Google Scholar
  28. 28.
    Soh, S.-E., Morris, M. E., & McGinley, J. L. (2011). Determinants of health-related quality of life in Parkinson’s disease: A systematic review. Parkinsonism & Related Disorders, 17(1), 1–9.Google Scholar
  29. 29.
    Gage, H., Hendricks, A., Zhang, S., & Kazis, L. (2003). The relative health related quality of life of veterans with Parkinson’s disease. Journal of Neurology, Neurosurgery and Psychiatry, 74(2), 163–169.Google Scholar
  30. 30.
    Carod-Artal, F. J., Vargas, A. P., & Martinez-Martin, P. (2007). Determinants of quality of life in Brazilian patients with Parkinson’s disease. Movement Disorders: Official Journal of the Movement Disorder Society, 22(10), 1408–1415.Google Scholar
  31. 31.
    Goldsworthy, B., & Knowles, S. (2008). Caregiving for Parkinson’s disease patients: An exploration of a stress-appraisal model for quality of life and burden. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 63(6), P372–P376.Google Scholar
  32. 32.
    Dowding, C. H., Shenton, C. L., & Salek, S. S. (2006). A review of the health-related quality of life and economic impact of Parkinson’s disease. Drugs and Aging, 23(9), 693–721.Google Scholar
  33. 33.
    Martinez-Martin, P., Schapira, A. H., Stocchi, F., Sethi, K., Odin, P., MacPhee, G., et al. (2007). Prevalence of nonmotor symptoms in Parkinson’s disease in an international setting; study using nonmotor symptoms questionnaire in 545 patients. Movement Disorders: Official Journal of the Movement Disorder Society, 22(11), 1623–1629.Google Scholar
  34. 34.
    Martin, S. (2015). Psychosocial challenges epxerienced by partners of people with Parkinson’s disease. Journal of Neuroscince Nursing, 47(4), 211–222.Google Scholar
  35. 35.
    Clyburn, L. D., Stones, M. J., Hadjistavropoulos, T., & Tuokko, H. (2000). Predicting caregiver burden and depression in Alzheimer’s disease. Journals of Gerontology Series b, 55(1), S2–S13.Google Scholar
  36. 36.
    Neri, A. L., Yassuda, M. S., Fortes-Burgos, A. C. G., Mantovani, E. P., Arbex, F. S., de Souza Torres, S. V., et al. (2012). Relationships between gender, age, family conditions, physical and mental health, and social isolation of elderly caregivers. International Psychogeriatrics, 24(3), 472–483.Google Scholar
  37. 37.
    Sanyal, J., Das, S., Ghosh, E., Banerjee, T., Bhaskar, L., & Rao, V. R. (2015). Burden among Parkinson’s disease care givers for a community based study from India. Journal of the Neurological Sciences, 358(1–2), 276–281.Google Scholar
  38. 38.
    Pinquart, M., & Sörensen, S. (2003). Differences between caregivers and noncaregivers in psychological health and physical health: A meta-analysis. Psychology and Aging, 18(2), 250.Google Scholar
  39. 39.
    Carter, R. (2008). Addressing the caregiving crisis. Preventing Chronic Disease, 5, 1.Google Scholar
  40. 40.
    Happe, S., & Berger, K. (2002). The association between caregiver burden and sleep disturbances in partners of patients with Parkinson’s disease. Age and Ageing, 31(5), 349–354.Google Scholar
  41. 41.
    Happe, S., Lüdemann, P., & Berger, K. (2002). The association between disease severity and sleep-related problems in patients with Parkinson’s disease. Neuropsychobiology, 46(2), 90–96.Google Scholar
  42. 42.
    Martínez-Martín, P., Benito-Leon, J., Alonso, F., Catalan, M. J., Pondal, M., Zamarbide, I., et al. (2005). Quality of life of caregivers in Parkinson’s disease. Quality of Life Research, 14(2), 463–472.Google Scholar
  43. 43.
    Miller, E., Berrios, G., & Politynska, B. (1996). Caring for someone with Parkinson’s disease: Factors that contribute to distress. International Journal of Geriatric Psychiatry, 11(3), 263–268.Google Scholar
  44. 44.
    Kabat-Zinn, J. (2013). Full catastrophe living, revised edition: How to cope with stress, pain and illness using mindfulness meditation. Hachette UK.Google Scholar
  45. 45.
    Baer, R. (2003). Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice, 10(2), 125–143.  https://doi.org/10.1093/clipsy.bpg015.Google Scholar
  46. 46.
    Creswell, J. D. (2017). Mindfulness interventions. Annual Review of Psychology, 68, 491–516.Google Scholar
  47. 47.
    Carmody, J., Baer, R. A., Lykins, L. B., & Olendzki, N. (2009). An empirical study of the mechanisms of mindfulness in a mindfulness-based stress reduction program. Journal of Clinical Psychology, 65(6), 613–626.Google Scholar
  48. 48.
    McLean, G., Lawrence, M., Simpson, R., & Mercer, S. (2017). Mindfulness-based stress reduction in Parkinson’s disease: A systematic review. BMC Neurology, 17(1), 92.Google Scholar
  49. 49.
    Pickut, B., Vanneste, S., Hirsch, M. A., Van Hecke, W., Kerckhofs, E., Mariën, P., et al. (2015). Mindfulness training among individuals with Parkinson’s disease: Neurobehavioral effects. Parkinson’s Disease, 2015(2015), 816404.Google Scholar
  50. 50.
    Pickut, B. A., Van Hecke, W., Kerckhofs, E., Mariën, P., Vanneste, S., Cras, P., et al. (2013). Mindfulness based intervention in Parkinson’s disease leads to structural brain changes on MRI: A randomized controlled longitudinal trial. Clinical Neurology and Neurosurgery, 115(12), 2419–2425.Google Scholar
  51. 51.
    Cash, T. V., Ekouevi, V. S., Kilbourn, C., & Lageman, S. K. (2016). Pilot study of a mindfulness-based group intervention for individuals with Parkinson’s disease and their caregivers. Mindfulness, 7(2), 361–371.Google Scholar
  52. 52.
    Kwok, J. Y. Y., Kwan, J. C., Auyeung, M., Mok, V. C. T., Lau, C. K. Y., Choi, K. C., & Chan, H. Y. L. (2019). Effects of mindfulness yoga vs stretching and resistance training exercises on anxiety and depression for people with parkinson disease: a randomized clinical trial. JAMA Neurology.  https://doi.org/10.1001/jamaneurol.2019.0534.Google Scholar
  53. 53.
    Brown, K. W., Ryan, R. M., & Creswell, J. D. (2007). Mindfulness: Theoretical foundations and evidence for its salutary effects. Psychological Inquiry, 18(4), 211–237.Google Scholar
  54. 54.
    Rau, H. K., & Williams, P. G. (2016). Dispositional mindfulness: A critical review of construct validation research. Personality and Individual Differences, 93, 32–43.Google Scholar
  55. 55.
    Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84(4), 822.Google Scholar
  56. 56.
    Zimmaro, L. A., Salmon, P., Naidu, H., Rowe, J., Phillips, K., Rebholz, W. N., et al. (2016). Association of dispositional mindfulness with stress, cortisol, and well-being among university undergraduate students. Mindfulness, 7(4), 874–885.Google Scholar
  57. 57.
    Bränström, R., Duncan, L. G., & Moskowitz, J. T. (2011). The association between dispositional mindfulness, psychological well-being, and perceived health in a Swedish population-based sample. British Journal of Health Psychology, 16(2), 300–316.Google Scholar
  58. 58.
    Barnes, V. A., Pendergrast, R. A., Harshfield, G. A., & Treiber, F. A. (2008). Impact of breathing awareness meditation on ambulatory blood pressure and sodium handling in prehypertensive African American adolescents. Ethnicity and Disease, 18(1), 1.Google Scholar
  59. 59.
    Pakenham, K. I., & Samios, C. (2013). Couples coping with multiple sclerosis: A dyadic perspective on the roles of mindfulness and acceptance. Journal of Behavioral Medicine, 36(4), 389–400.Google Scholar
  60. 60.
    Moynihan, J. A., Chapman, B. P., Klorman, R., Krasner, M. S., Duberstein, P. R., Brown, K. W., et al. (2013). Mindfulness-based stress reduction for older adults: Effects on executive function, frontal alpha asymmetry and immune function. Neuropsychobiology, 68(1), 34–43.Google Scholar
  61. 61.
    Wen, M., Hawkley, L. C., & Cacioppo, J. T. (2006). Objective and perceived neighborhood environment, individual SES and psychosocial factors, and self-rated health: An analysis of older adults in Cook County, Illinois. Social Science & Medicine, 63(10), 2575–2590.Google Scholar
  62. 62.
    Sims, R. C., Hosey, M., Levy, S.-A., Whitfield, K. E., Katzel, L. I., & Waldstein, S. R. (2014). Distinct functions of social support and cognitive function among older adults. Experimental Aging Research, 40(1), 40–59.Google Scholar
  63. 63.
    Anderson, J. R., Carroll, I., Azcarate-Peril, M. A., Rochette, A. D., Heinberg, L. J., Peat, C., et al. (2017). A preliminary examination of gut microbiota, sleep, and cognitive flexibility in healthy older adults. Sleep Medicine, 38, 104–107.Google Scholar
  64. 64.
    Ronaldson, A., Gazali, A. M., Zalli, A., Kaiser, F., Thompson, S. J., Henderson, B., et al. (2016). Increased percentages of regulatory T cells are associated with inflammatory and neuroendocrine responses to acute psychological stress and poorer health status in older men and women. Psychopharmacology (Berl), 233(9), 1661–1668.Google Scholar
  65. 65.
    Gibb, W., & Lees, A. (1988). The relevance of the Lewy body to the pathogenesis of idiopathic Parkinson’s disease. Journal of Neurology, Neurosurgery and Psychiatry, 51(6), 745–752.Google Scholar
  66. 66.
    Folstein, M. F., Robins, L. N., & Helzer, J. E. (1983). The mini-mental state examination. Archives of General Psychiatry, 40(7), 812.Google Scholar
  67. 67.
    Hoehn, M. M., & Yahr, M. D. (1998). Parkinsonism: Onset, progression, and mortality. Neurology, 50(2), 318.Google Scholar
  68. 68.
    de Frias, C. M., & Whyne, E. (2015). Stress on health-related quality of life in older adults: The protective nature of mindfulness. Aging & Mental Health, 19(3), 201–206.Google Scholar
  69. 69.
    Pradhan, E. K., Baumgarten, M., Langenberg, P., Handwerger, B., Gilpin, A. K., Magyari, T., et al. (2007). Effect of mindfulness-based stress reduction in rheumatoid arthritis patients. Arthritis Care & Research, 57(7), 1134–1142.Google Scholar
  70. 70.
    Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, 385–396.Google Scholar
  71. 71.
    Cohen, S., Hoberman, H. M., Kamarck, T., & Mermelstein, R. (1983). Interpersonal support evaluation list. Leiden: Martinus Nijhoff publishers.Google Scholar
  72. 72.
    Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Beck depression inventory. San Antonio., 78(2), 490–498.Google Scholar
  73. 73.
    Buysse, D. J., Reynolds, C. F., III, Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Research, 28(2), 193–213.Google Scholar
  74. 74.
    Alessi, C. A., Martin, J. L., Webber, A. P., Alam, T., Littner, M. R., Harker, J. O., et al. (2008). More daytime sleeping predicts less functional recovery among older people undergoing inpatient post-acute rehabilitation. Sleep, 31(9), 1291–1300.Google Scholar
  75. 75.
    Taibi, D. M., & Vitiello, M. V. (2011). A pilot study of gentle yoga for sleep disturbance in women with osteoarthritis. Sleep Medicine, 12(5), 512–517.Google Scholar
  76. 76.
    Ware, J. E., Jr., & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Medical Care, 30, 473–483.Google Scholar
  77. 77.
    Lyons, R. A., Perry, I. M., & Littlepage, B. N. (1994). Evidence for the validity of the Short-form 36 Questionnaire (SF-36) in an elderly population. Age and Ageing, 23(3), 182–184.Google Scholar
  78. 78.
    Kenny, D. A., Kashy, D. A., & Cook, W. L. (2006). Dyadic analysis. New York: Guilford Press.Google Scholar
  79. 79.
    Enders, C. K., & Tofighi, D. (2007). Centering predictor variables in cross-sectional multilevel models: A new look at an old issue. Psychological Methods, 12(2), 121.Google Scholar
  80. 80.
    Tamagawa, R., Giese-Davis, J., Speca, M., Doll, R., Stephen, J., & Carlson, L. E. (2013). Trait mindfulness, repression, suppression, and self-reported mood and stress symptoms among women with breast cancer. Journal of Clinical Psychology, 69(3), 264–277.Google Scholar
  81. 81.
    Dorsey, E., Constantinescu, R., Thompson, J., Biglan, K., Holloway, R., Kieburtz, K., et al. (2007). Projected number of people with Parkinson disease in the most populous nations, 2005 through 2030. Neurology, 68(5), 384–386.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Psychological & Brain SciencesUniversity of LouisvilleLouisvilleUSA
  2. 2.Department of NeurologyUniversity of California San DiegoSan DiegoUSA
  3. 3.Department of PsychologyFrazier Rehabilitation HospitalLouisvilleUSA
  4. 4.Department of PsychiatryUniversity of California San DiegoSan DiegoUSA
  5. 5.Kent School of Social WorkUniversity of LouisvilleLouisvilleUSA

Personalised recommendations