Mary MittelmanMary Mittelman, D.P.H.
Research Professor, New York University, Langone Medical Center, recipient of a 2004 Zenith Fellows Award

In her own words, investigator Dr. Mary Mittelman, describes her research and what receiving Association funding has meant to her career.

Research focus

I received a Zenith Fellows Award from the Alzheimer's Association to systematically test, for the first time, the effectiveness of counseling for couples in which the husband or wife had early-stage Alzheimer's disease. While couples counseling is an established therapeutic modality and clinicians may offer it in their practices, it had not been rigorously evaluated in this population.

Impact of Association funding
"With the support of the Zenith Fellows Award, we developed a couples counseling intervention to focus directly on relationship distress."

Our hypothesis was that counseling the members of the couple together would significantly improve their relationship. With the support of the Zenith Fellows Award, we developed a couples counseling intervention to focus directly on relationship distress. The intervention was tested through a pilot study at the Center of Excellence on Brain Aging at New York University's Langone Medical Center and was designed to support the relationship, mitigate negative effects of the illness and potentially reduce depression for both individuals. The counseling sessions provided a supportive environment in which members of the couple could share their emotional reactions to the diagnosis with each other. Helping couples address their current reactions and consider future plans and needs was one of the key roles of the counselor.

Counseling as an intervention

The intervention consisted of six counseling sessions in two months. Forty-one couples were randomly assigned to receive the intervention immediately (20 couples) or participate in the control group (21 couples) and receive the intervention afterward if desired. Comprehensive written assessments were recorded at baseline and at the two- and four-month follow-up sessions. After the four-month follow-up, couples in the control group were offered the intervention. All participants received ad hoc counseling from the time of enrollment. Among well spouses, 61 percent were women. The average age of the well spouses was 72.8 (range, 52–89); the average age of people with Alzheimer's was 76.3 (range, 55–91). The overall dropout rate of 19.5 percent (eight of 41 couples) is not uncommon in this population.

Effect on relationship quality

The intervention had a significant effect on well spouses' evaluation of their relationship with their partners, as indicated by the Dyadic Adjustment Scale (DAS), a well-known scale that measures relationship quality. A significant improvement in the DAS occurred from baseline to the two-month follow-up for well spouses in the intervention group compared with those in the control group. This was maintained at the four-month follow-up. A significant difference was also seen between the two groups in the Goal Attainment Scale, with both well spouses and people with Alzheimer's disease in the intervention group more likely to have achieved their goals at the two-month follow-up than those in the control group. Couples in the intervention group also reported improved communication.

Study participants shared their appreciation with the staff for having had the opportunity to express thoughts and feelings they previously felt were too frightening or dangerous to convey to each other. They also expressed appreciation for discovering that the relationship could continue to support the integrity and value of each member despite the impact of the illness. Most well spouses said they were surprised at how communicative their ill spouses were during the counseling sessions. Interestingly, after participating in the intervention, 11 of the men with Alzheimer's disease joined an early-stage support group run by one of the counselors.

Moving research forward

Results of this pilot study suggest that providing counseling to couples while the functional impact of the illness is still relatively mild can have a significant positive effect on their relationship. Results from this Zenith Fellows Award–supported study were published in two articles appearing in the peer-reviewed journal Clinical Gerontologist.

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