ADRD spousal caregivers, loneliness, & immune dysregulation: Real-Time, real-world intervention targets

照顾患有阿尔茨海默病或相关痴呆症（ADRD）的配偶是生活中最紧张的事情之一 经验，其特点是照顾者的负担，悲伤，发病率和早产率较高， mortality.然而，在ADRD配偶照顾者的精神和身体方面， 健康模式。ADRD配偶照顾者容易出现社会孤立和孤独，两种独立但相关的情况 结构认为燃料在ADRD配偶照顾者的身体和心理健康问题。知之甚少 关于孤独，社会隔离，以及它们的时间动态和相互作用如何在现实中实时发挥作用， 真实世界这是不幸的，因为痴呆症配偶照顾者的客观社会孤立的经验， 和孤独感，以及他们同时的生理状态，都在不断地实时变化， 时间动态的星座，近端瞬时因素（例如，地点、时间、任务/压力源、质量和 最近的社会互动类型），关系期望、情感和行为的类特质模式（例如， 依恋取向）和社会文化条件。300名ADRD配偶的社会文化多样性队列 照顾者将回答有关他们的心理健康（照顾者负担，抑郁和悲伤）的问题，并提供 血液，以评价促炎细胞因子和两种相关的炎症表型决定因素，细胞 老化和疾病（即，线粒体和糖酵解功能），并在两次随访访视期间（2 基线后6周和6个月）。他们还将通过自我报告提供个人内部和社会背景数据。 在第1次访问和第2次访问之间的2周间隔内，为期14天的生态评估将提供以下方面的瞬时数据 孤独、抑郁情绪、瞬间情境（例如，当前位置，社会背景，日常活动，活动 和非刺激性压力源。使用先进的智能手表，我们成功地试点在ADRD配偶 护理人员，我们将不断评估迷走神经介导的心率变异性。Aim 1模拟瞬间 孤独、抑郁情绪和迷走神经介导的心率变异性之间的关系; Aim 1还将 模拟孤独（严重程度和变异性）对ADRD配偶精神照顾者指标的影响 健康（照顾者负担，抑郁和悲伤）和身体健康（炎症，线粒体和糖酵解 功能）随时间。目标2调查短暂的孤独感、ADRD配偶之间是否存在联系 照顾者的心理健康和身体健康指数被瞬间的环境所改变，并且相对稳定 自我的指数（即，附件取向）和上下文（即，社会文化因素）。目的 3个（探索性）模型，用于建立vmHRV对ADRD配偶心理护理健康指数的影响（照顾者 负担、抑郁和悲伤）和身体健康（炎症、线粒体和糖酵解功能）。

Caregiving for a spouse with Alzheimer's disease or a related dementia (ADRD) is among life's most stressful experiences and is characterized by caregiver burden, grief, and higher rates of morbidity and premature mortality. Yet, there is considerable unexplained variability in ADRD spousal caregivers' mental and physical health patterns. ADRD spousal caregivers are prone to social isolation and loneliness, two separate but related constructs thought to fuel physical and mental health problems in ADRD spousal caregivers. Very little is known about how loneliness, social isolation, and their temporal dynamics and interactions play out in real-time in the real-world. This is unfortunate because dementia spousal caregivers' experiences of objective social isolation and loneliness, and their concurrent physiological state, are constantly changing in real-time based on a constellation of temporal dynamics, proximal momentary factors (e.g., location, time, tasks/stressors, quality and type of recent social interaction), trait-like patterns of relational expectations, emotions, and behaviors (e.g., attachment orientations), and sociocultural conditions. A socio-culturally diverse cohort of 300 ADRD spousal caregivers will answer questions about their mental wellbeing (caregiver burden, depression & grief) and provide blood to evaluate proinflammatory cytokine and two related determinants of inflammatory phenotypes, cellular aging, and disease (i.e., mitochondrial, and glycolytic function) at baseline, and during two follow-up visits (2 weeks and 6 months after baseline). They will also provide intrapersonal and socio-contextual data by self-report. During a 2- week gap between visits 1 and 2, a 14-day ecological assessment will provide momentary data on loneliness, depressive affect, momentary context (e.g., current location, social context, daily activities, caregiving and non-caregiving stressors. Using a sophisticated smartwatch we successfully piloted in ADRD spousal caregivers, we will continuously evaluate vagally mediated heart rate variability. Aim 1 models the momentary associations between loneliness, depressive affect, and vagally mediated heart rate variability; Aim 1 will also model the impact of loneliness (both severity and variability) on indices of ADRD spousal caregiver mental wellbeing (caregiver burden, depression & grief), and physical health (inflammation, mitochondrial and glycolytic function) over time. Aim 2 investigates whether associations between momentary loneliness, ADRD spousal caregiver mental wellbeing, and physical health indices are modified by momentary context, and relatively stable indices of intrapersonal (i.e., attachment orientation) and contextual (i.e., sociocultural conditions) factors. Aim 3 (exploratory) models the impact of vmHRV on indices of ADRD spousal mental care wellbeing (caregiver burden, depression & grief), and physical health (inflammation, mitochondrial and glycolytic function) over time.