Pathways from Stress to Metabolic Syndrome and Health Decline in Aged Caregivers

描述（由申请人提供）：非正式照顾者报告的压力率始终高于非照顾者，有证据表明慢性压力对身体健康和认知功能有不利影响。然而，没有研究评估照顾相关压力和健康下降之间的生物学过程。最近关于应激诱导代谢综合征和健康衰退的理论提出了一个合理的机制：慢性应激破坏了几个相互关联的稳态系统（神经内分泌、HPA轴和免疫系统），从而导致代谢综合征和随后的健康衰退。拟议的研究将评估这些关联超过3年期间在400老年护理人员和非护理人员从波士顿，MA大都会地区。护理人员将从波士顿大学阿尔茨海默病核心中心登记处招募（n=200）。非护理人员将从哈佛大学老龄化合作项目登记处招募（n=200）。数据将在BU普通临床研究中心的4次年度访谈中收集。24小时尿液（儿茶酚胺和皮质醇）、血清（DHEAS、IL-6、葡萄糖、甘油三酯和高密度脂蛋白胆固醇）的生物学测量；将采取血压和拟人化措施。在每次访谈中，将通过访谈者管理的问卷收集有关压力源、照顾情况（来自Pearlin's Caregiver Stress model的测量）、潜在混杂因素和影响修饰因素的数据。功能状态将基于行走速度、椅子站立和自我报告的adl。认知状态将基于多个领域（例如，执行功能，工作记忆）。假设将涉及：1)从压力到生理变化、代谢综合征、功能和认知衰退的顺序途径；2)非照顾者和非照顾者这些结果的比较；(3)社会支持和照顾特征等修饰因子对这一通路的影响机制。混合效应模型将用于分析照顾者压力与功能和认知变化之间的纵向过程。潜在增长曲线模型将用于检查时变协变量（即照顾者转换）对四个测量点的个体内变化的影响。研究结果将为老年护理人员健康下降的生物学途径提供洞见，并对减少慢性应激不良影响的干预措施具有启示意义。

DESCRIPTION (provided by applicant): Informal caregivers consistently report higher rates of stress than non-caregivers, and there is evidence that chronic stress has adverse effects on physical health and cognitive functioning. However, no study has evaluated the biological processes between caregiving-related stress and health decline. Recent theories of stress-induced metabolic syndrome and health decline suggest a plausible mechanism: chronic stress disrupts several interrelated homeostatic systems (neuroendocrine, HPA axis, and immune systems), which lead to metabolic syndrome and subsequent health decline. The proposed study will evaluate these associations over a 3-year period in 400 elderly caregivers and non-caregivers from the Boston, MA metropolitan area. Caregivers will be recruited from the Boston University Alzheimer's Disease Core Center Registry (n=200). Non-caregivers will be recruited from the Harvard Cooperative Program on Aging Registry (n=200). Data will be collected during 4 annual interviews at the BU General Clinical Research Center. Biological measures will be obtained from 24-hour urine (catecholamines and cortisol), serum (DHEAS, IL-6, glucose, triglycerides and HDL cholesterol); blood pressure and anthropomorphic measures will be taken. Data on stressors, the caregiving situation (measures from Pearlin's Caregiver Stress model), and potential confounders and effect modifiers will be collected through interviewer-administered questionnaires at each interview. Functional status will be based on walking speed, chair stands and self-reported ADLs. Cognitive status will be based on multiple domains (e.g., executive functioning, working memory). Hypotheses will address: 1) the sequential pathway from stress, to physiological changes, metabolic syndrome, and functional and cognitive decline; 2) comparisons of these outcomes in non-caregivers and non-caregivers; and 3) the mechanisms by which modifiers, such as social support and caregiving characteristics, affect this pathway. Mixed effects models will be used to analyze the longitudinal process between caregiver stress and functional and cognitive changes. Latent growth curve modeling will be used to examine the effects of time-varying covariates (i.e., caregiver transitions) on intra-individual change across the four measurement points. Results will provide insight into biological pathways underlying health decline in aged caregivers, and have implications for interventions to reduce adverse effects of chronic stress.