Biological, psychological and clinical markers of caregiver's stress in impaired elderly with dementia and age-related disease

Dyadic Wind of Change: New Approaches to Improve Biopsychological Stress Regulation in Patients with Dementia and Their Spousal Caregivers

Patients with dementia (PWD) and their caregivers experience long-term stress, leading to accelerated disease progression and to stress-related morbidity. Previous research focused on intrapersonal biopsychological stress responses. Quite recently, dyadic interrelations between caregivers and PWD and their effects on stress and caregiver burden have received more attention, giving rise to dyadic intervention studies. However, while it is of importance to consider both the patient and the caregiver from a dyadic point of view, evaluation of these dyadic interventions considering underlying mechanisms is still lacking. We therefore extend the current literature on dyadic processes between PWD and caregivers by transferring the knowledge about underlying stress-modulating dyadic processes in healthy couples to the dementia patient-caregiver constellation. By targeting dyadic stress co-regulation between PWD and caregivers, we expect significant therapeutic effectiveness. The aims of this article are two-fold: 1) We aim to provide a rationale for incremental benefits of considering dyadic processes among caregivers and PWD by means of elucidating underlying mechanisms and 2) we aim to emphasize the need to evaluate these underlying mechanisms by means of objective physiological stress markers in both PWD and caregivers. Knowledge on these underlying mechanisms will ultimately help developing dyadic interventions tailored to the needs of both PWD and their caregivers.

A systematic review of the psychobiological burden of informal caregiving for patients with dementia: Focus on cognitive and biological markers of chronic stress

As the physiological impact of chronic stress is difficult to study in humans, naturalistic stressors are invaluable sources of information in this area. This review systematically evaluates the research literature examining biomarkers of chronic stress, including neurocognition, in informal dementia caregivers. We identified 151 papers for inclusion in the final review, including papers examining differences between caregivers and controls as well as interventions aimed at counteracting the biological burden of chronic caregiving stress. Results indicate that cortisol was increased in caregivers in a majority of studies examining this biomarker. There was mixed evidence for differences in epinephrine, norepinephrine and other cardiovascular markers. There was a high level of heterogeneity in immune system measures. Caregivers performed more poorly on attention and executive functioning tests. There was mixed evidence for memory performance. Interventions to reduce stress improved cognition but had mixed effects on cortisol. Risk of bias was generally low to moderate. Given the rising need for family caregivers worldwide, the implications of these findings can no longer be neglected.

Gender differences in clusters of NPS in Dutch nursing homes - a factor analysis

BACKGROUND

Neuropsychiatric symptoms (NPS) have a high prevalence among patients with dementia, up to 80%. NPS can be grouped by type and stage of dementia. However, NPS have not previously been grouped by gender. Our objective was to investigate whether NPS cluster differently in men or women in the nursing home patients.

METHODS

Factor analysis to assess the clustering of items in the Cohen-Mansfield Agitation Inventory (CMAI) and Neuropsychiatric Inventory-Nursing home version (NPI-NH) into components, for both scales and for gender. Differences in symptom clustering between male and female patients were assessed using a three-step procedure: (1) identifying a gender specific distinctive item, (2) describe the correlation between the distinctive item with any other item in this cluster, (3) testing whether the correlation between a distinctive item and any other item in the cluster (which is present in both sexes) is different for males and females using a general linear model.

RESULTS

Our database consisted of 1,609 patients. There were five male and three female clusters for NPI-NH and eight male and seven female clusters for CMAI. There were three distinctive items in the NPI-NH and ten in the CMAI.

CONCLUSIONS

There are other clusters of NPS in males and females. Our analysis revealed more significant relations in female than male patients. This might have an implication on the clinical course.

Salivary cortisol and immunoglobulin A: responses to stress as predictors of health complaints reported by caregivers of offspring with autistic spectrum disorder

In the caregiving model of chronic stress, few studies have been conducted with young middle-aged samples and no data exists about acute stress response in this population. To extend knowledge in this issue, health complaints and psychological, endocrine, and immunological responses to stress have been assessed in a cross-sectional sample of 41 parents of offspring with autistic spectrum disorder (ASD) in comparison with 37 non-caregiver parents. Salivary cortisol and immunoglobulin A (IgA) levels were measured before, during, and after a mental psychosocial stressor, while mood and state anxiety were evaluated before and after the stress. Health complaints, personality traits, socio-economic status, and characteristics of the care recipient were assessed. Caregivers reported more health complaints showing buffered cortisol and IgA responses and greater increases in fatigue to acute stress than the controls. In terms of predictive power of health complaints, IgA levels, care status, and severity of the care recipient are especially relevant for caregivers. Results strongly suggest a dysregulation in the immune and hormonal stress-induced responses in middle-aged caregivers, with immune component and care characteristics as the main modulators of health complaints. A deficit in the adaptive capability of stress response is plausible in this population, emphasizing the need to consider family approaches when planning protocols for assistance to ASD patients.

Sex differences in the prevalence of behavioral and psychological symptoms of dementia

BACKGROUND

When a person has dementia, non-cognitive behaviors and symptoms might constitute a greater problem than the cognitive decline itself. Male or female sex might be a predisposing factor for certain types of behavior disturbances and symptoms. The aim of the present analysis was to explore the correlation between sex and the prevalence of behavioral and psychological symptoms of dementia.

METHOD

A total of 3395 people with cognitive impairment (1056 men and 2339 women) were selected from two large cross-sectional surveys of those in geriatric care settings, conducted in 1982 and 2000 in the county of Västerbotten, Sweden. Symptoms were assessed using the Multi-Dimensional Dementia Assessment Scale (MDDAS), and prevalence was compared using multivariate logistic regression. Drug data were obtained from prescription records.

RESULTS

For 17 out of 39 behaviors and symptoms, the prevalence differed significantly between men and women. Men more often exhibited aggressive behavior and regressive behaviors, and women more often exhibited depressive symptoms. There were no sex differences for passiveness and hallucinations. The prevalence of antipsychotic drug use was higher among men (35.5% compared to 28.9%, p < 0.001) and antidepressant drug use higher among women (30.1% compared to 25.6%, p = 0.006). The prevalence of use of anxiolytics, hypnotics and sedatives did not differ.

CONCLUSION

There are some differences in the prevalence of behavioral and psychological symptoms of dementia between men and women. These different symptom profiles might possibly explain some of the differences found in the pharmacological treatment of men and women with a dementia disorder.