Linda Clare

University of Exeter, Exeter, England, United Kingdom

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Publications (193)509.87 Total impact

  • Catherine Quinn · Linda Clare · Robert T Woods ·
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    ABSTRACT: Informal dementia caregiving has traditionally been perceived as an extremely stressful process; however, more recent research has started to focus on the positive aspects of providing care. Studies indicate that caregivers who derive something positive out of caregiving have better well-being. However, there has been little exploration of the factors linked to caregivers identifying positive aspects of providing care. The aim of the current study was to explore the predictors of finding meaning in caregiving. This was a cross-sectional questionnaire study in which the respondents were 447 caregivers of people with dementia who were in receipt of a specialist nursing service. The questionnaire contained measures of meaning, relationship quality, caregivers' motivations to provide care, role captivity and caregiving competence. Correlational analyses showed that higher meaning was associated with being a spousal caregiver, providing greater hours of care, higher religiosity, a better pre-caregiving and current relationship quality, higher competence, lower role captivity, higher intrinsic motivations and higher extrinsic motivations. Hierarchical regression analyses indicated that variance in finding meaning was significantly predicted by high religiosity, high competence, high intrinsic motivations and low role captivity. From these findings, it is recommended that interventions should help caregivers focus on positive aspects of providing care and enhance their feelings of competence. Copyright © 2012 John Wiley & Sons, Ltd.
    International Journal of Geriatric Psychiatry 11/2012; 27(11):1195-202. DOI:10.1002/gps.3773 · 2.87 Impact Factor
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    ABSTRACT: Background: Although recent diagnostic criteria for Alzheimer's disease propose the use of biomarkers, validation of these biomarkers by diagnostic test accuracy studies is a necessary first step, followed by the synthesis of the evidence from these studies in systematic reviews and meta-analyses. The quality of the resulting evidence depends on the number and size of the primary studies, their quality, and the adequacy of their reporting. This systematic review assesses the weight and quality of the evidence available from primary diagnostic test accuracy studies. Methods: A MEDLINE search was performed in August 2011 to identify all potentially relevant publications relating to the biomarkers β-amyloid, tau, positron emission tomography ((18)F-fluorodeoxyglucose or ligands for amyloid), or magnetic resonance imaging (MRI). The reporting and methodology were assessed using the Standards for Reporting of Diagnostic Accuracy and Quality Assessment of Diagnostic Accuracy Studies assessment tools, respectively. Because clinical progression to dementia is the most commonly used reference standard, this review focuses on participants with objective cognitive impairment but no dementia at baseline. Results: Of the 19,104 published references identified by the search, 142 longitudinal studies relating to the biomarkers of interest were identified, which included subjects who had objective cognitive impairment but no dementia at baseline. The highest number of studies (n = 70) and of participants (n = 4722) related to structural MRI. MRI also yielded the highest number of studies with extractable data for meta-analysis (n = 32 [46% of all structural MRI studies]), followed by cerebrospinal fluid tau (n = 24 [73%]). There were few studies on positron emission tomography ligands for amyloid having suitable data for meta-analysis (n = 4). There was considerable variation across studies in reporting outcomes, methods of blinding and selection, means of accounting for indeterminate or missing values, the interval between the test and assessments, and the determination of test thresholds. Conclusions: The body of evidence for biomarkers is not large and is variable across the different types of biomarkers. Important information is missing from many study reports, highlighting the need for standardization of methodology and reporting to improve the rigor of biomarker validation.
    Alzheimer's & dementia: the journal of the Alzheimer's Association 10/2012; 9(3). DOI:10.1016/j.jalz.2012.01.014 · 12.41 Impact Factor
  • Judith L Roberts · Linda Clare ·
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    ABSTRACT: Awareness in mild cognitive impairment (MCI) has been studied primarily from a quantitative perspective, which has yielded inconclusive results. A qualitative approach may provide a more in-depth profile of awareness of symptoms and changes among people living with MCI. Few qualitative studies have considered awareness in MCI; therefore, the focus here will be on the experience of living with MCI, and particularly on the psychological impact of living with memory difficulties and how these impact on daily life. Twenty five participants with a clinical diagnosis of MCI who had been informed of their diagnosis were interviewed. Interpretative phenomenological analysis was used to analyse interview transcripts. Four higher order themes were identified. An exploratory model is proposed with a dominant theme of 'Fear and uncertainty'; this underpins 'Interdependence', 'Life goes on as normal' and 'Disavowal of difficulty' which are representative of coping responses resulting from appraisal of memory and cognitive difficulties. Participants did not use the term 'MCI', suggesting that this term had little meaning for them; nevertheless, there was a wish for a definitive explanation of the difficulties. The themes elicited from participant accounts indicate that the symptoms of MCI are perceived as a threat to psychological well-being which results in context-specific appraisal of the symptoms of MCI.
    Aging and Mental Health 10/2012; 17(3). DOI:10.1080/13607863.2012.732033 · 1.75 Impact Factor
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    ABSTRACT: Background: The extent to which care home residents with severe dementia show awareness is influenced by the extent to which the environment provides opportunities for engagement and by the way in which care staff interact with them. We aimed to establish whether training care staff to observe and identify signs of awareness in residents with severe dementia resulted in improved quality of life for residents. Methods: In this pilot cluster randomized trial, care staff in four homes (n = 32) received training and supervision and carried out structured observations of residents using the AwareCare measure (n = 32) over an eight-week period, while staff in four control homes (n = 33) had no training with regard to their residents (n = 33) and no contact with the research team. The primary outcome was resident quality of life. Secondary outcomes were resident well-being, behavior and cognition, staff attitudes and well-being, and care practices in the home. Results: Following intervention, residents in the intervention group had significantly better quality of life as rated by family members than those in the control group, but care staff ratings of quality of life did not differ. There were no other significant between-group differences. Staff participating in the intervention identified benefits in terms of their understanding of residents' needs. Conclusions: Staff were able to use the observational measure effectively and relatives of residents in the intervention homes perceived an improvement in their quality of life.
    International Psychogeriatrics 07/2012; 25(1):1-12. DOI:10.1017/S1041610212001226 · 1.93 Impact Factor
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    ABSTRACT: Lifestyle factors playing a role in the development of late-life disability may be modifiable. There is a need for robust evidence about the potential for prevention of disability through behavior change interventions. This feasibility study involves the development, implementation and initial testing of a behavior change intervention in a naturalistic setting. A small-scale randomized controlled trial (RCT) will investigate the implementation of a goal-setting intervention aimed at promoting behavior change in the domains of physical and cognitive activity in the context of a community resource center for over-50s. Healthy older participants attending the center (n = 75) will be randomized to one of three conditions: control (an interview involving a general discussion about the center); goal-setting (an interview involving identification of up to five personal goals in the domains of physical activity, cognitive activity, diet and health, and social engagement); or goal-setting with mentoring (the goal-setting interview followed by bi-monthly telephone mentoring). All participants will be reassessed after 12 months. Primary outcomes are levels of physical and cognitive activity. Secondary outcomes address psychosocial (self-efficacy, mood, quality of life), cognitive (memory and executive function), and physical fitness (functional and metabolic) domains. Cost-effectiveness will also be examined. This study will provide information about the feasibility of a community-based lifestyle intervention model for over-50s and of the implementation of a goal-setting intervention for behavior change, together with initial evidence about the short-term effects of goal-setting on behavior. Current Controlled Trials ISRCTN30080637 (
    Trials 07/2012; 13(1):115. DOI:10.1186/1745-6215-13-115 · 1.73 Impact Factor
  • Linda Clare ·

    Alzheimer's and Dementia 07/2012; 8(4):P2. DOI:10.1016/j.jalz.2012.05.008 · 12.41 Impact Factor

  • Alzheimer's and Dementia 07/2012; 8(4):P235. DOI:10.1016/j.jalz.2012.05.622 · 12.41 Impact Factor

  • Alzheimer's and Dementia 07/2012; 8(4):P728. DOI:10.1016/j.jalz.2012.05.1965 · 12.41 Impact Factor
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    ABSTRACT: Background: Numerous theoretical models have been developed to explore how caregiving can impact on caregiving outcomes. However, limited attention has been given to the effects of caregivers’ motivations for providing care, the meaning they find in caregiving, and the nature of their relationship with the care-recipient. The current study explored the associations between intrinsic and extrinsic motivations, ability to find meaning in caregiving, and pre-caregiving and current relationship quality, and the way in which these variables interact to influence caregiving outcomes. Methods: This was a cross-sectional questionnaire study, in which the respondents were 447 caregivers of people with dementia who were in receipt of a specialist nursing service. Results: The results showed that intrinsic motivations, meaning, and pre-caregiving and current relationship quality were significantly related to each other, while extrinsic motivations were only related to intrinsic motivations and meaning. All these factors were significantly related to caregiving outcomes as measured by caregiver burden, role captivity, and competence. Conclusions: Based on these findings, it is recommended that interventions aimed at reducing caregiving stress should take into account the impact of the quality of the relationship and the caregivers’ motivations for providing care. More longitudinal research is needed to explore how meanings, motivations, and relationship quality change over the caregiving career.
    International Psychogeriatrics 06/2012; 24(11):1816-26. DOI:10.1017/S1041610212000889 · 1.93 Impact Factor
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    Anthony Martyr · Linda Clare ·
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    ABSTRACT: The assessment of executive function (EF) and activities of daily living (ADL) are important elements in the diagnosis of Alzheimer's disease. Following a comprehensive search in three databases, a random-effects meta-analysis was used to investigate the association between ADL ability and seventeen tests of EF, three tests of attention and working memory and the Mini-Mental State Examination. The association between EF and ADL ability was further investigated in relation to four different methods of assessing ADL, and one specific ADL, driving. Forty-nine studies met the inclusion criteria, and a total of 3,663 participants were included, the majority of whom were diagnosed with Alzheimer's disease. Most of the individual tests, including commonly used tests of EF such as the Clock Drawing Test, Letter Fluency and the Trail Making Test Part B, showed a significant moderate association with ADL. Associations between EF and ADL ability were similar for all four methods of assessing ADL ability. Driving ability was also moderately associated with EF. The meta-analysis suggests a consistent moderate association between ADL and EF, supporting the growing evidence for a link between ADL and executive dysfunction in early dementia. full text (free access) available from here:
    Dementia and Geriatric Cognitive Disorders 05/2012; 33(2-3):189-203. DOI:10.1159/000338233 · 3.55 Impact Factor
  • Sharon M Nelis · Linda Clare · Christopher J Whitaker ·
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    ABSTRACT: The process of developing and living with dementia may activate attachment feelings and behaviours in people with dementia (PwD) and their carers. By obtaining information from both PwD and carer, we aimed to provide information on the nature and concordance of attachment patterns within the dyad and to examine the relative contribution of attachment representations in PwD and carers to the well-being of both parties. Ninety-seven PwD and their carers completed categorical and dimensional ratings of attachment. PwD also rated their self-concept, mood and quality of life. Carers rated the functional ability of PwD and neuropsychiatric symptoms and measures of subjective well-being. People with dementia reported more insecure than secure attachment, with the most frequently reported style being dismissive attachment. Attachment security for PwD was related to more positive self-concept and less symptoms of anxiety. Attachment was not related to quality of life in PwD, but mood and self-concept were strong predictors of quality of life. Carer attachment security was related to their psychological health. Distress at symptoms and MMSE score of the PwD were the strongest predictors of stress. There was no association between PwD and carer attachment styles; PwD working models of attachment did not predict carer well-being and vice versa. Attachment representations may be important for the psychological well-being of PwD and carers, but there was no evidence of the reciprocal nature of attachment within these dyads.
    Aging and Mental Health 04/2012; 16(7):845-54. DOI:10.1080/13607863.2012.667779 · 1.75 Impact Factor
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    ABSTRACT: Among individuals with episodic memory impairments, trial-and-error learning is less successful than when errors are avoided. This "errorless learning advantage" has been replicated numerous times, but its neurocognitive mechanism is uncertain, with existing evidence pointing to both medial temporal lobe (MTL) and frontal lobe (FL) involvement. To test the relative contribution of MTL and FL functioning to the errorless learning advantage, 51 healthy older adults were pre-experimentally assigned to one of four groups based on their neuropsychological test performance: Low MTL-Low FL, Low MTL-High FL, High MTL-Low FL, High MTL-High FL. Participants learned two word lists under errorless learning conditions, and two word lists under errorful learning conditions, and memory was tested via free recall, cued recall, and source recognition. Performance on all three tests was better for those with High relative to Low MTL functioning. An errorless learning advantage was found in free and cued recall, in cued recall marginally more so for those with Low than High MTL functioning. Participants with Low MTL functioning were also more likely to misclassify learning errors as target words. Overall, these results are consistent with a MTL locus of the errorless learning advantage. The results are discussed in terms of the multi-componential nature of neuropsychological tests and the impact of demographic and mood variables on cognitive functioning.
    Neuropsychological Rehabilitation 04/2012; 22(2):169-86. DOI:10.1080/09602011.2011.639609 · 1.96 Impact Factor
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    ABSTRACT: Assessment of activities of daily living is an important element in the diagnosis of dementia, with research suggesting a link between functional ability and cognition. We investigated the relationship between self- and informant ratings of instrumental activities of daily living (iADL) and verbal executive functioning in early-stage dementia. A total of 96 people with early-stage Alzheimer's disease or vascular or mixed dementia and their carers completed the Functional Activities Questionnaire; people with dementia also completed a test of letter fluency. Letter fluency was associated with self-ratings of iADL, while informant ratings of iADL were associated with the age and Mini-Mental State Examination score of the person with dementia. Self-ratings of perceived functioning suggested significantly less impairment than informant ratings. Those with impaired letter fluency rated themselves as having greater difficulties in iADLs than those who performed better. People with early-stage dementia vary in their subjective level of awareness of their iADL functioning, and difficulties with language production may contribute to better awareness of iADL impairments.
    The Clinical Neuropsychologist 03/2012; 26(3):501-19. DOI:10.1080/13854046.2012.665482 · 1.72 Impact Factor
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    ABSTRACT: Recent research has established that individuals with amnestic mild cognitive impairment (aMCI) have impaired prospective memory (PM); however, findings regarding differential deficits on time-based versus event-based PM have been less clear. Furthermore, the diagnostic utility of PM measures has received scant attention. Healthy older adults (n = 84) and individuals with aMCI (n = 84) were compared on the Cambridge Prospective Memory Test (CAMPROMPT) and two single-trial event-based PM tasks. The aMCI participants showed global impairment on all PM measures. Measures of retrospective memory and complex attention predicted both time and event PM performance for the aMCI group. Each of the PM measures was useful for discriminating aMCI from healthy older adults and the time- and event-based scales of the CAMPROMPT were equivalent in their discriminative ability. Surprisingly, the brief PM tasks were as good as more comprehensive measures of PM (CAMPROMPT) at predicting aMCI. Results indicate that single-trial PM measures, easily integrated into clinical practice, may be useful screening tools for identifying aMCI. As PM requires retrospective memory skills along with complex attention and executive skills, the interaction between these skills may explain the global PM deficits in aMCI and the good discriminative ability of PM for diagnosing aMCI.
    Journal of the International Neuropsychological Society 03/2012; 18(2):295-304. DOI:10.1017/S135561771100172X · 2.96 Impact Factor
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    ABSTRACT: Amnestic mild cognitive impairment (aMCI) delineates a population at high risk for subsequently developing Alzheimer's disease (AD)--that is, people with preclinical AD. Associative episodic memory tasks are particularly sensitive to preclinical AD; however, they often lack ecological validity, which is important when evaluating performance in daily activities. We describe the development of two quasi-everyday associative memory tasks--the La Trobe Face-Name test and the La Trobe Numberplate task--and their utility in profiling and separating 70 aMCI participants from 101 healthy older adults (HOA) compared with standard episodic memory tasks. aMCI participants performed significantly worse overall and demonstrated a greater forgetting rate than HOA on both tasks. The everyday tasks separated aMCI from HOA participants as effectively as standard episodic memory tasks and were well tolerated. These tasks provide a valuable addition to neuropsychologists' toolkits with enhanced ecological (verisimilitude) and face validity for assisting in counseling clients, measuring the effect of interventions, and profiling everyday memory performance in HOA and aMCI.
    Journal of Clinical and Experimental Neuropsychology 03/2012; 34(3):269-78. DOI:10.1080/13803395.2011.633498 · 2.08 Impact Factor
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    ABSTRACT: In early-stage dementia, awareness at the meta-representational level involving a person's appraisal of his/her own condition and its implications has usually been assessed by interview, but contextual factors may influence responding. We examined the utility of an indirect, vignette-based method of eliciting awareness. Three vignettes describing early-stage dementia, established dementia and healthy ageing were used to elicit views of the problem and the kinds of advice that might be helpful for the characters depicted. Responses were obtained from 91 people with early-stage Alzheimer's, vascular or mixed dementia, 87 carers and 80 older controls. For the participants with dementia, awareness was assessed in separate in-depth interviews and rated on a five-point scale for comparison purposes. Participants with dementia were often able to correctly identify the problems described in the vignettes, although scoring lower than carers or controls. Participants with dementia were also able to offer advice for those depicted, although to a lesser extent than carers or controls. Ability to offer advice was greater where MMSE scores were higher. For participants with dementia, vignette scores were moderately correlated with ratings derived from interviews, and those showing limited or no awareness offered fewer items of advice than those showing some or good awareness. In addition, 29% of participants with dementia spontaneously pointed out similarities between their own condition and that of the person depicted. The vignette method may be useful where resources preclude the use of in-depth interviews, and may supplement in-depth interviews as part of a multi-dimensional assessment of awareness.
    Aging and Mental Health 02/2012; 16(5):566-75. DOI:10.1080/13607863.2011.652594 · 1.75 Impact Factor
  • Lisa S Caddell · Linda Clare ·
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    ABSTRACT: Objectives: The aim of the study was to investigate the relationships between identity and cognitive and functional abilities in people with early-stage dementia. Method: Fifty people in the early stages of dementia completed measures of identity and cognitive and functional abilities, including autobiographical memory. Multiple regression analyzes were used to determine whether it was possible to predict any of the variance in identity from cognitive and functional abilities, or from autobiographical memory alone. Results: It was possible to predict approximately a quarter of the variance in two out of three aspects of identity from cognitive and functional abilities. The relationships between aspects of identity and autobiographical memory functioning were very weak. Discussion: The relationship between identity and cognitive and functional abilities is not straightforward. There is no evidence to suggest a linear relationship between an overall decline in cognitive functioning and a deterioration in identity.
    Aging Neuropsychology and Cognition 02/2012; 20(1). DOI:10.1080/13825585.2012.656575 · 1.07 Impact Factor
  • Lisa S Caddell · Linda Clare ·
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    ABSTRACT: There is little empirical research regarding the relationships between identity and well-being in people with dementia. The aim of the study was to explore the relationship of identity with mood and quality of life (QoL) in the people in the early stages of dementia. This was a cross-sectional questionnaire-based study. Fifty people in the early stages of dementia completed measures pertaining to different aspects of identity, mood, and QoL. Multiple regression analyses were carried out to determine whether it was possible to predict any of the variance in mood and QoL from aspects of identity. It was possible to predict 12.8% of the variance in anxiety, 23.4% of the variance in depression, and 25.1% of the variance in QoL from different aspects of identity. Predictors varied for each dependent variable. Aspects of identity predict a modest proportion of the variance in anxiety, depression, and QoL. This suggests that supporting identity in people with dementia who are experiencing difficulties in this regard might have a positive impact on mood and QoL. However, the majority of the variance in mood and QoL must be accounted for by other variables.
    International Psychogeriatrics 02/2012; 24(8):1306-15. DOI:10.1017/S104161021100278X · 1.93 Impact Factor
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    ABSTRACT: Insufficient attention has been paid to the influence of psychological and social factors on discrepancy-based measures of awareness. The present study tested a biopsychosocial model of awareness in early-stage dementia by gathering evidence regarding the relative contributions of neuropsychological, individual psychological and social factors to the level of scoring on measures used to index awareness. Awareness was assessed in relation to memory, activities of daily living and social functioning in 101 individuals with early-stage dementia participating in the Memory Impairment and Dementia Awareness (MIDAS) Study. People with dementia (PwD) and carers also completed measures of individual psychological and social variables, and PwD completed measures of neuropsychological functioning. Scores on discrepancy-based indices of awareness and on the self-ratings and informant ratings contributing to these indices were associated with a range of factors including neuropsychological functioning of PwD, individual traits and dispositions and current affective functioning of PwD, socio-demographic characteristics of PwD and carers, carer well-being and carer perceptions of PwD and of quality of relationship with PwD. Patterns of association varied across domains of functioning. The findings support the relevance of a biopsychosocial approach to understanding the factors that influence unawareness of impairment in dementia.
    International Journal of Geriatric Psychiatry 02/2012; 27(2):167-77. DOI:10.1002/gps.2705 · 2.87 Impact Factor
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    ABSTRACT: Signs of sensory and perceptual awareness can be observed in people with very severe dementia, and may be influenced by the extent to which the environment offers appropriate stimulation. We developed an observational tool, AwareCare, which care staff can use to identify signs of awareness in residents with very severe dementia, based on the concept of the Wessex Head Injury Matrix (WHIM). Using WHIM items as a guide, and following focus groups with care staff and family members, an expert panel identified 28 environmental stimuli and 35 response categories for the initial version of AwareCare. After baseline assessments of cognition, well-being and quality of life were taken, 40 residents were observed individually for 30 minutes on 5 occasions. Based on the observational data, 10 stimulus categories and 14 response categories were identified for further analysis and formed the final version of AwareCare. All participants showed awareness to varying degrees. Social stimuli elicited the most responses. Greater awareness was associated with better cognitive function, self-care, mobility, and responsiveness, but not with proxy-rated quality of life. Understanding the nature of awareness in this group is an important element in ensuring appropriate levels of interaction and stimulation, and hence enhancing quality of care.
    Neuropsychological Rehabilitation 01/2012; 22(1):113-33. DOI:10.1080/09602011.2011.640467 · 1.96 Impact Factor

Publication Stats

5k Citations
509.87 Total Impact Points


  • 2015
    • University of Exeter
      • Department of Psychology
      Exeter, England, United Kingdom
  • 2004-2015
    • Bangor University
      • School of Psychology
      Бангор, Wales, United Kingdom
  • 2014
    • University of Toronto
      • Department of Psychology
      Toronto, Ontario, Canada
  • 1999-2010
    • University College London
      • Department of Clinical, Educational and Health Psychology
      Londinium, England, United Kingdom
  • 2009
    • Hinchingbrooke Health Care NHS Trust
      Huntingdon, England, United Kingdom
  • 2004-2008
    • University of Wales
      Cardiff, Wales, United Kingdom