Adverse Childhood Experiences and Individual Differences among Dementia Spousal Caregivers: A Biobehavioral Approach to Stress Across the Lifespan

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Project Summary/Abstract Caregiving for a spouse with Alzheimer's disease (AD) is one of the most stressful experiences a person can encounter. Chronic psychological stress promotes a systemic pro-inflammatory state, which can negatively impact diseases of older adulthood and aging. “Inflammaging” is an emerging term characterizing the chronic, systemic inflammation in aging that is an important indicator of morbidity and mortality. Thus, chronic stress associated with AD caregiving negatively impacts health by dysregulating the immune system and increasing chronic inflammation. However, not all caregivers experience the same amount of risk. Adverse childhood experiences are potentially traumatic events that occur in childhood and exacerbate stress-induced adult immune dysregulation (i.e., elevated proinflammatory cytokine production) throughout the lifespan. Adverse childhood experiences dysregulate an individual's physiological response to stress, increasing the risk for adverse health outcomes when experiencing chronic stress later in life (i.e., as an AD spousal caregiver). The mechanisms underlying the relationship between adverse childhood experiences and chronic stress in older adulthood are not fully understood. Adverse childhood experiences cause deficits in inhibitory control, which may lead to negative outcomes when facing a chronic stressor in older adulthood. Inhibitory control refers to the capacity to control unwanted thoughts or actions, including an individual's ability to regulate their emotional responses during times of stress. Given the impact that inhibitory control has on regulating stress, inhibitory control is an important mechanism to examine among those experiencing chronic stress in older adulthood. The objectives of this application are to (1) characterize the relationships between AD spousal caregivers' history of adverse childhood experiences and biomarkers of spousal caregiver physical health (i.e., elevated inflammation) and AD spousal caregiver wellbeing and (2) evaluate models linking adverse childhood experiences and inhibitory control with physical health (i.e., elevated inflammation) and AD spousal caregiver well-being. The approach is to recruit 110 AD spousal caregivers as part of the parent NIH R01 study. Participants will complete self-report assessments of adverse childhood experiences, inhibitory control, health, caregiver burden, grief symptoms, and quality of life. Participants will complete an “Emotional Face Go/Nogo” laboratory behavioral task to assess inhibitory control and complete a blood draw to evaluate stress-related biomarkers (i.e., inflammation). The proposed study will advance scientific knowledge of individual risk factors for disease and premature aging among AD spousal caregivers. Further understanding of the underlying mechanisms of stress across the lifespan can be helpful in forecasting age-related disease and premature aging. The project will provide mechanistic findings, allow researchers and clinicians to identify at-risk AD spousal caregivers better, and open new avenues for tailored interventions.