The experiences of adult children caring for a parent with Korsakoff’s syndrome

This article presents a qualitative meta-synthesis that explores the experiences of adult children of parents with a mental illness. There has been growing interest in the experiences of children whose parents have mental illness. However, little literature explores the experiences of adult children. Qualitative meta-synthesis. A review of English language literature search engines was undertaken and identified 905 relevant articles. Articles were excluded if they used quantitative methodology, had other methodological issues or had a focus on parental drug/alcohol issues. Twelve articles were identified as using qualitative or mixed methods studies, which were reviewed using the Critical Appraisal Skills Programme (Public Health Resource Unit 2006). Following this, seven studies were included in the meta-synthesis. The main findings and themes identified by the original study authors were extracted from the results and discussions sections and further categorised into four main themes using content analysis methods. There were 26 themes identified by the meta-synthesis, which were collated into four wider categories and concepts. Issues related to family relationships, external familial relationship changes, the adult child's emotional reflections and illness-related concepts were identified. There is a paucity of qualitative research that considers adult children's experiences of parental mental illness. In the available studies, issues related to family relationships, external familial wider relationship changes, the adult child's emotional reflections and illness-related concepts were identified as being of concern to adults who experienced parental mental illness during childhood. There is a need for all health and social care services to be aware of the experiences/needs of adult children who have experienced parental mental illness. Adult children of parents with mental illnesses should be provided with opportunities to discuss their stories to validate their experiences.

There is a limited body of research that focuses on experiences of families of people with mental illness. While the body of knowledge concerning children of parents with mental illness is increasing, there remains limited discourse surrounding the experiences of adults who have lived with childhood parental mental illness. This paper examined one major theme of a study focusing on parenting narratives of adults who had experienced childhood parental mental illness. The narrative study from a metropolitan area of Australia reflects adult children's experiences of being overwhelmed with parental mental illness. They felt unsure of their own emotions and felt they had lost a sense of who they were as individual people. Adult children felt confused about their sense of reality, particularly for those whose parent had a diagnosis of schizophrenia or psychosis. Their experiences of loss were closely associated with changing self identity. Furthermore, many of the narratives demonstrated experiences of grief for adult children. Greater understanding of adult children's perceptions of being parented by a person with mental illness, alongside their experiences of loss, has the potential to help health and social care professionals to facilitate greater resilience for families who are living with parental mental illness.

ObjectivesIn this study, the researchers examined adult children's experience during and after their parents' late‐life divorce. The study applies a familial/dyadic perspective. Family systems theory is used heuristically.BackgroundLate‐life divorce is rising due to increased social legitimacy of divorce and life‐expectancy. As parents age, their adult children become more involved in their parents' lives. Accordingly, adult children are expected to fulfill roles in their parents' life transitions such as late‐life divorce. However, adult children's experiences regarding their parents late‐life divorce is not as available in previous studies, especially from a dyadic/familial perspective.MethodSemistructured in‐depth qualitative‐interviews were conducted separately with 51 participants (28 adult children, 23 parents) composed of seven family units (n = 33) and nine parent–child‐dyads (n = 18). Thematic analysis and dyadic interview analysis were used.ResultsDuring the divorce, adult children experienced meaningful roles supporting their parents, mediating between them, or pushing them to finalize the divorce. Some avoided involvement. Parents described roles they assigned to their adult children and their consequences. After divorce, adult children continued supporting their parents, experiencing role reversal earlier than expected. Their new roles included relieving loneliness and worry and providing care.ConclusionThe roles adult children experience reveals unique challenges for adult‐child–parent relationships after parents' late‐life divorce, influencing the family system.ImplicationsConceptualizing adult children's roles and the implications for family systems contributes to theoretical knowledge. Family counselors should provide families with relevant tools to deal with these consequences. Policy makers and training programs for family therapy should address the consequences of late‐life divorce.

Alcohol use disorder is a chronic disease characterized by an inappropriate pattern of drinking, resulting in negative consequences for the individual's physical, mental and social health. Korsakoff's syndrome is a complication of alcohol use disorder and is characterized by severe memory and executive deficits. The fronto-cerebellar and Papez circuits are structurally affected in patients with alcohol use disorder with and without Korsakoff's syndrome. The first objective of the present study was to measure the effect of chronic and excessive alcohol consumption on resting-state functional connectivity of these two functional brain networks. The second objective was to identify, for the first time, resting-state functional connectivity abnormalities specific to amnesic patients with Korsakoff's syndrome. In the present study, a neuropsychological assessment and a resting-state functional magnetic resonance imaging examination were conducted in 31 healthy controls (43.6 ± 6.1 years) and 46 patients (46.6 ± 9.1 years) with alcohol use disorder including 14 patients with Korsakoff's syndrome (55.5 ± 5.3 years) to examine the effect of chronic and heavy alcohol consumption on functional connectivity of the fronto-cerebellar and the Papez circuits at rest and the specificity of functional connectivity changes in Korsakoff's syndrome compared to alcohol use disorder without Korsakoff's syndrome. The resting-state functional connectivity analyses focused on the nodes of the fronto-cerebellar and Papez circuits and combined region of interest and graph theory approaches, and whether these alterations are associated with the neuropsychological profile. In patients pooled together compared to controls, lower global efficiency was observed in the fronto-cerebellar circuit. In addition, certain regions of the fronto-cerebellar and Papez circuits were functionally hyperconnected at rest, which positively correlated with executive functions. Patients with Korsakoff's syndrome showed lower resting-state functional connectivity, lower local and global efficiency within the Papez circuit compared to those without Korsakoff's syndrome. Resting-state functional connectivity positively correlated with several cognitive scores in patients with Korsakoff's syndrome. The fronto-cerebellar and Papez circuits, two normally well-segregated networks, are functionally altered by alcohol use disorder. The Papez circuit attempts to compensate for deficits in the fronto-cerebellar circuit, albeit insufficiently as evidenced by patients' overall lower cognitive performance. Korsakoff's syndrome is characterized by altered functional connectivity in the Papez circuit known to be centrally involved in memory.

Alcohol use disorder (AUD) patients without Korsakoff's syndrome (KS) report a variable self-rated sleep quality. Their ability to accurately judge their sleep quality may be related to their alcohol-related cognitive deficits and brain damage. KS patients, who present severe brain dysfunction, may be cognitively unable to judge their sleep quality. The aim of the present study is to examine, in AUD and KS patients, whether the absence of sleep complaint is associated with altered brain structure and impaired cognitive abilities within specific cerebral networks. An assessment of subjective sleep quality was conducted in 20 healthy controls, 37 AUD patients, and 17 KS patients. Patients were first pooled together and then classified into 2 groups (no-complaintAUD+KS and complaintAUD+KS ) according to the total Pittsburg Sleep Quality Index score. Cognitive scores, gray matter (GM) volume, and white matter (WM) integrity were compared between these 2 groups, and then in AUD and KS patients separately. Poor sleep quality was reported by 70% of AUD and 18% of KS patients. Compared to controls, both no-complaintAUD+KS and complaintAUD+KS presented cortical and subcortical alterations as well as episodic memory deficits, which were more severe in patients without sleep complaint. Only no-complaintAUD+KS presented executive deficits. Then, considering the clinical diagnosis, GM volume in frontotemporal regions, WM integrity, and executive functions were affected to the same extent in AUD and KS patients without sleep complaint. Our results confirm the high prevalence of sleep complaint in AUD patients and the rare complaint in KS patients. In AUD and KS patients, the absence of sleep complaint may not indicate good sleep quality but rather reflect executive deficits and frontothalamic damage. Alcohol-related cognitive deficits may indeed alter the ability to self-evaluate sleep quality, suggesting that the use of sleep questionnaire should be considered with caution in patients with executive deficits.

Adult children often help their older parents maintain independence at home, and this informal caregiving can be overwhelming and challenging to balance with other aspects of life. Yet, adult children's requirements tend to be overlooked when designing technologies to foster aging in place. In this work, we use reflexive thematic analysis to study Reddit content to understand the experiences of adult caregivers and the issues that they face in supporting their parents. The pseudonymous data allowed us to explore three research questions: 1) What are the experiences of adult children as informal helpers for elderly parents? 2) How do adult children currently manage their role as informal helpers? and 3) How might digital technology facilitate communication between aging parents and adult children as informal helpers? Our findings lead to a number of design considerations for technologies that support adult children caring for parents who are aging in place, including: building common ground, establishing boundaries, addressing guilt, encouraging in-person communication, community support for adult children, and adapting to changes in role reciprocity.

Research suggests that adult children of parents with harmful alcohol use are at increased risk for premature death. This national cohort study investigated mortality in adult children of parents with alcohol use disorder (AUD), adjusting for sociodemographic variables. The study used 1973 to 2018 data from Swedish national registers to compare mortality risk in children who had ≥ 1 parent with AUD (ICD-10 code F10 and its ICD-8 and ICD-9 equivalents) (n = 122,947) and those who did not (n = 2,298,532). A Cox regression model adjusted for year of birth, sex, parental education, and childhood loss of a parent was used. Before the age of 18 years, about 5% of children born in Sweden lived with ≥ 1 parent who had a clinical diagnosis of AUD. Overall mortality was higher in adult children of parents with AUD: hazard ratio (HR) 1.76, 95% confidence interval (CI) 1.71–1.82. Mortality remained elevated after adjustments for sociodemographic factors (HR 1.45, 95% CI 1.40–1.50). Children of parents with AUD had increased mortality from all investigated causes. The highest excess risk was for death from drug-related causes (excluding accidental poisonings) (HR 3.08, 95% CI 2.74–3.46). For most causes, mortality was higher if the mother had AUD than if the father had AUD. Patterns of mortality were similar in both sexes. This study provides evidence that parental AUD raises the risk of offspring mortality from preventable causes such as drug use, suicide (HR 2.16, 95% CI 1.98–2.36), accident (HR 2.00, 95% CI 1.87–2.13), and assault (HR 1.76, 95% CI 1.38–2.24).

Alcohol Use Disorder (AUD) results in sleep disturbances that may have deleterious impacts on cognition, especially on memory. However, little is known about the sleep architecture in patients with Korsakoff's syndrome (KS). This study aims at characterizing sleep disturbances in KS compared to AUD without KS and at specifying the relationships with cognitive impairments. Twenty-nine AUD patients (22 without KS and 7 with KS) and 15 healthy controls underwent a neuropsychological assessment and a polysomnography. The severity of sleep-disordered breathing and sleep fragmentation was similar in AUD and KS patients compared to controls. Sleep architecture differed between both patient groups: the proportion of slow-wave sleep was reduced in AUD patients only, while a lower proportion of rapid-eye movement (REM) sleep was specifically observed in KS patients. The proportion of REM sleep correlated with the severity of episodic memory deficits when AUD and KS were examined together. These data provide evidence for both similarities and specificities regarding sleep alterations in AUD patients with and without KS. They also indicate that altered sleep architecture may contribute to the pathophysiology of alcohol-related memory disorders.

The experiences of children who live with parental mental illness are becoming increasingly recognized. However, there remains a limited body of knowledge in relation to an individual's longer term experiences. This study sought adult children's experiences of childhood parental mental illness. It generated reflections of 13 adult children who had lived with parents with mental illness during their childhood. The narrative design of the study facilitated a voice for participants. The paper presents one main theme of the findings. The findings offer a unique insight into childhood awareness of social stigmas and children's behavioural changes to avoid disclosure of parental mental illness. Participants noted that they were aware of social stigmas associated with mental illness during their childhood. This contributed to their fear of disclosure to others that fuelled a culture of familial secrecy, reinforcing the children's own sense of difference. Further work is required to enhance community understanding about the familial journeys of parental mental illness and the impact of negative‐natured stigmas.

Children who have lived with parental mental illness experience long-standing reduced health and social outcomes, alongside ongoing personal distress. While there has been some dialogue regarding interventions to support children who are living with parental mental illness, there remains a paucity of knowledge regarding adult children's experiences and potential needs. Given this, the aim of the present study was to establish parenting narratives of adult children who had experienced childhood parental mental illness. This included their experiences of being parented alongside their own subsequent parenting roles. Three men and 10 women, ranging from 30 to 78years old, met individually with a researcher to tell their stories. Narratives were thematically analysed to establish themes. The findings of the study demonstrated that individuals who have lived with childhood parental mental illness dehumanized their parent with mental illness. The authors argue that all mental health services should be underpinned with a whole of family assessment and care philosophy. There is also a need for all mental health services to consider how policies and procedures might inadvertently dehumanize clients who are parents, which could contribute to familial dehumanization. This could prevent the dehumanization of parents who experience mental illness to preserve parental and child relationships.

Chronic and excessive alcohol consumption can result in alcohol use disorder (AUD) without neurological complications and in Korsakoff's syndrome (KS) when combined with thiamine deficiency. These two clinical forms are accompanied by widespread structural brain damage in both the fronto-cerebellar (FCC) and Papez circuits (PC) as well as in the parietal cortex, resulting in cognitive and motor deficits. BEARNI is a screening tool especially designed to detect neuropsychological impairments in AUD. However, the sensitivity of this tool to the structural brain damage of AUD and KS patients remains unknown. Eighteen KS patients, 47 AUD patients and 27 healthy controls (HC) underwent the BEARNI test and a 3T-MRI examination. Multiple regression analyses conducted between GM density and performance on each BEARNI subtest revealed correlations with regions included in the FCC, PC, thalamus and posterior cortex (precuneus and calcarine regions). All these brain regions were altered in KS compared to HC, in agreement with the cognitive deficits observed in the corresponding BEARNI subtests. The comparison between KS and AUD regarding the GM density in the several nodes of the FCC and calcarine regions revealed that they were atrophied to the same extent, suggesting that BEARNI is sensitive to the severity of alcohol-related GM abnormalities. Within the PC, the density of the cingulate cortex and thalamus, which correlated with the memory and fluency subscores, was smaller in KS than in AUD, suggesting that BEARNI is sensitive to specific brain abnormalities occurring in KS.

The aims of this qualitative study were to explore the experience of being an adult child of a parent with serious mental illness and how adult children have coped with their experience. Children of parents with serious mental illness are a potentially vulnerable group because of risk factors associated with parental mental illness. While there has been considerable research into factors that may strengthen or impair their well-being, there has been little exploration of the subjective experience of growing up with parental mental illnesses such as schizophrenia. An interpretive qualitative design including autoethnography. Unstructured narrative interview and written narrative data from 10 participants were analysed using van Manen's hermeneutic method. Four themes that captured the experience of being the adult child of a parent with serious mental illness were revealed: (1) Being uncertain: `you'd think this roller coaster was never going to stop'; (2) Struggling to connect: `we were super close and now we're not'; (3) Being responsible: `I think I grew up in a hurry'; (4) Seeking balance: `I had to be in control of the situation so awful things wouldn't happen'. Being the adult child of a parent with serious mental illness can involve a chaotic family life where adult children assume substantial caregiving roles. Relationships between parents and adult children can become strained. However, support from others including health professionals can strengthen adult children's resilience and ability to cope with these challenges. Nurses in a range of health care settings are in prime positions to intervene early and provide information and support for children and families where parents have a mental illness. Family-focused care can strengthen children's and parent's relationships and support the family's ability to cope.

This study explores the experiences of adult children as they transition their functionally and/or cognitively declining aging parents from independent living to supervised housing. A qualitative grounded theory approach was used to chronicle the experiences of adult children as their caregiving responsibilities intensified and their parents' health declined. Purposive, snowball sampling was used to enlist adult children (n = 16) who were in the process of transitioning an aging parent from an independent living situation to one providing assistance with everyday care and tasks. Semi-structured telephone interviews were conducted and designed to follow a pattern of increased frailty of the parent(s) and escalating involvement of the adult child. Two major themes emerged from the data: Changing places and everlasting love. Adult children began to intervene when cognitive or physical declines compromised the safety and well-being of the older adult and began to assume responsibility for day-to-day needs. As disabilities intensified, adult children relied on siblings, friends, social services, and health care providers to assist in planning and implementing caregiving responsibilities. Deep respect and abiding love of the aging parent(s) sustained the adult child throughout the caregiving experience.

BackgroundGrowing up with parental alcohol use disorder (AUD) is a risk factor for psychiatric disorders. This study investigated the risk of mood disorders and of anxiety disorders in the adult...

Alcohol use disorder (AUD) is associated with episodic memory impairments, executive dysfunction, and craving. These cognitive and behavioral alterations are related to brain abnormalities in 3 thalamocortical loops involving different thalamic nuclei. First, when AUD is combined with thiamine deficiency, the anterior nuclei are especially affected, leading to severe dysfunction within the Papez circuit and to the development of Korsakoff’s syndrome (KS). Although episodic memory disorders occur in AUD patients without KS, the specific relationships between the anterior nuclei integrity and episodic memory performance have received little attention in AUD and KS patients. Second, chronic and excessive alcohol consumption also results in dysfunction of the frontocerebellar circuit that theoretically includes the mediodorsal nuclei. Altered executive abilities and motor disorders associated with this system can thus be observed both in AUD patients with and without KS. In AUD, these executive deficits contribute to the persistence of drinking behaviors, hamper psychosocial treatment, and favor relapse. Third, craving, the irrepressible urge to consume a substance or engage in an activity, is now a central feature of AUD and is hypothesized to be subserved by a thalamo-insular circuit involving the ventromedial nuclei of the thalamus. Alterations to several thalamocortical loops thus contribute to the development, persistence, and complications of AUD. The literature reviewed shows a clear involvement of different thalamic nuclei in components of AUD functional sequelae.