Alzheimer Caregiver Coping: Mental and Physical Health

阿尔茨海默病护理人员应对：心理和身体健康

• 批准号: 7265643
• 负责人: IGOR GRANT
• 金额: $ 78.59万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 1997
• 资助国家: 美国
• 起止时间: 1997-09-30 至 2012-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7265643
• 关键词: Acute; Adrenergic Agents; Affect; Affective; Age; Aging-Related Process; Alzheimer' s Disease; Anxiety; Arousal; Arteriosclerosis; Atherosclerosis; Attenuated; Baroreflex; Bereavement; Biological; Biological Markers; Blood; Blood Coagulation Factor; Blood Pressure; Blood Vessels; Buffers; Cardiovascular Diseases; Cardiovascular system; Caregiver Burden; Caregivers; Caring; Carotid Arteries; Catecholamines; Cells; Cessation of life; Characteristics; Cholesterol; Chronic; Coagulation Process; Complement Factor D; Data; Dementia; Diabetes Mellitus; Disease; Elderly; Elements; Elevation; Endothelial Cells; Endothelium; Environment; Event; Exhibits; Extravasation; Fibrin fragment D; Figs - dietary; Functional disorder; Funding; Future; Grant; Gray unit of radiation dose; Health; Hemostatic function; Home environment; Hypertension; Immune; Individual; Inflammation; Inflammatory; Injury; Insulin Resistance; Interleukin-6; Intervention; Investigation; Laboratories; Lead; Link; Measures; Medial; Mediating; Modeling; Morbidity - disease rate; Myocardial Infarction; Nitric Oxide; Numbers; Outcome; Participant; Pathology; Patients; Physiological; Placement; Principal Investigator; Problem behavior; Process; Psyche structure; Public Speaking; Published Comment; Regulation; Reporting; Research; Research Design; Research Personnel; Risk; Risk Factors; Risk Marker; Series; Severities; Site; Sleep; Sleep Disorders; Sleep disturbances; Spouse Caregiver; Spouses; Stimulus; Stress; Stroke; Sympathetic Nervous System; Testing; Text; Thick; Time; Translations; Update; Validation; Withdrawal; Work; adrenergic; age related; base; beta-adrenergic receptor; blood pressure regulation; cardiovascular disorder risk; cardiovascular injury; cardiovascular risk factor; caregiving; comparison group; coping; cytokine; depressive symptoms; desensitization; design; experience; frailty; heuristics; interest; migration; mortality; neurotransmitter release; normal aging; novel; positive mood; pressure; prevent; programs; psychobiologic; psychobiology; psychologic; receptor; receptor density; response; shear stress; sleep onset; stressor; trend; vasoconstriction

DESCRIPTION (provided by applicant): This Alzheimer Caregiver Study has been exploring the physiological and psychological mechanisms that may be associated with increased health risk in groups of elderly spousal caregivers (CG). Results indicate that CG experience increased sympathoadrenalmedullary (SAM) arousal, which may be related to sleep disturbance, and associated with physiological changes previously linked to risk of cardiovascular (CV) disease, such as increase in circulating catecholamines, rise in the procoagulant factor D dimer, and the proinflammatory marker IL-6. Older CG show greatest changes. In the renewal we wish to develop a more complete mechanistic understanding of the stress to CV risk translation. The general hypotheses are that specific elements of the caregiving situation, such as problem behaviors of the care recipient and lack of respite induce affective arousal and sleep problems which favor a state of increased SAM arousal. Chronic SAM excitation favors the release of inflammatory markers such as IL-6, and a shift toward procoagulation. These physiological changes, if chronic, may lead to CV vulnerability, including hypertension and vascular endothelial injury. The buffering effects of coping that emphasize mastery will also be explored. A novel focus of this renewal application is our proposal to link the major markers of psychobiological stress related to caregiving (i.e., affective arousal, sleep disturbance, and biomarkers such as catecholamines, hemostatis variables, inflammatory markers) to indicators of CV injury including degree of endothelial injury, early signs of larger vessel pathology and baroreflex desensitization. The study design involves repeated observation of 120 spousal caregivers of Alzheimer patients and a comparison group of 60 non-caregivers. Using our unique strategy of "taking the laboratory to the home", participants will be assessed annually (with added assessments following placement or death of care recipient) with respect to their caregiving situation, psychological status, and several biological indicators (e.g. SAM arousal, sleep disturbance, pro-inflammatory and hemostasis molecules, baroreflex, measures of endothelial function, and large vessel disease). This study will provide a basis for a mechanistic understanding of the path from CG stress to CV morbidity in elderly CG, and opens the possibility of targeted interventions to reduce this risk.

描述（由申请人提供）：这项阿尔茨海默氏症照顾者研究一直在探索可能与老年配偶照顾者（CG）群体健康风险增加相关的生理和心理机制。结果表明，CG的经验增加交感肾上腺髓质（SAM）唤醒，这可能与睡眠障碍，并与以前与心血管（CV）疾病的风险，如增加循环中的儿茶酚胺，促凝血因子D二聚体和促炎标志物IL-6的增加相关的生理变化。老CG显示最大的变化。在更新中，我们希望对压力到CV风险的转换有一个更完整的机械理解。一般的假设是，特定的元素，如问题行为的照顾接受者和缺乏喘息诱导情感唤醒和睡眠问题，有利于增加SAM唤醒的状态。慢性SAM兴奋有利于炎症标志物如IL-6的释放，并向促凝转变。这些生理变化，如果是慢性的，可能导致CV脆弱性，包括高血压和血管内皮损伤。强调掌握的应对的缓冲效应也将被探讨。这项更新申请的一个新焦点是我们建议将与抑郁相关的心理生物学压力的主要标志物（即，情感唤醒、睡眠障碍和生物标志物如儿茶酚胺、止血变量、炎症标志物）与CV损伤的指标（包括内皮损伤程度、较大血管病理学的早期体征和压力反射脱敏）相比较。研究设计包括重复观察120名阿尔茨海默病患者的配偶照顾者和60名非照顾者的对照组。使用我们独特的“将实验室带到家中”的策略，将每年对参与者进行评估（在护理接受者安置或死亡后进行额外评估），评估内容包括他们的生存状况、心理状态和几种生物指标（例如SAM觉醒、睡眠障碍、促炎和止血分子、压力反射、内皮功能测量和大血管疾病）。这项研究将提供一个机制的理解的路径CG压力CV发病率在老年CG的基础上，并打开了有针对性的干预措施，以减少这种风险的可能性。