Individual differences in dementia spousal caregiver burden: A biobehavioral approach

项目总结/摘要 照顾患有阿尔茨海默病（AD）的配偶是最紧张的经历之一， 人可以遇到。在已婚夫妇中，当二分体中的一个成员患有AD时，这种疾病通常是 被描述为一种关系性疾病，因为疾病的每一个方面都必然涉及配偶。贫困 生活质量（QOL）和照顾者负担的特点是一个显着比例的AD配偶照顾者。AD 配偶照顾者也经历了生活丧亲之痛，因为他们经历了类似的深刻的悲伤感 一个人在配偶去世时的感受配偶离婚的长期压力放大了年龄- 促炎细胞因子的相关变化，是发病率和死亡率的重要预测因素。 机械地，慢性应激促进糖皮质激素受体的脱敏，促进糖皮质激素 受体抵抗（GCR），这使得炎症增加。当然，并不是所有的AD配偶照顾者 处于同一风险水平。然而，试图确定哪些AD配偶照顾者处于 最大的风险是非常稀少的。在173项研究中， 关于AD配偶照顾者，据我们所知，没有研究如何关系和/或 人格特征影响身体健康的生物标志物。确定稳定的个体差异 特征对于开发循证治疗至关重要。依恋理论是一个有用的框架， 了解亲密关系中的个体差异以及人们如何科普压力生活 事件依恋不安全感有两种模式：依恋焦虑和依恋回避。人 高依恋焦虑者使用“过度激活”的情绪应对策略， 反应依恋回避度高的人会对依赖他人和使用感到不舒服 “去激活”应对策略，试图抑制压力。这个实验小组证明， 与低依恋焦虑的丧亲成年人相比，高依恋焦虑的新近丧亲成年人 焦虑者经历了更多的悲伤，更多的抑郁症状，以及更高的炎症。那些报告说 与那些报告较少悲伤的人相比，更多悲伤的人炎症水平升高。同样，那些 报告生活质量较差的人比报告生活质量较好的人有更高的炎症水平。我们的飞行员 工作在AD配偶照顾者呼应这些发现。我们还证明， 依恋回避与健康结果之间的关系受高心率变异性（HF-HRV）的调节， 衰老和情绪调节（HF-HRV）的重要标志。我们在失去亲人的成年人身上的发现的基础上， 推进我们对AD配偶照顾者最容易受到有害身体伤害的理解， 配偶痴呆症的健康影响，因为他们导航的生活丧亲之痛的经验，而 应对生育负担并努力维持生活质量。作为一个探索性的目标，我们将研究如何 这些依恋取向的个体差异会影响婚姻关系的双方成员。

Project Summary/ Abstract Caregiving for a spouse with Alzheimer’s Disease (AD) is one of the most stressful experiences a person can encounter. Among married couples when one member of the dyad has AD, the disease is often described as a relational illness because every aspect of the disease necessarily involves the spouse. Poor quality of life (QOL) and caregiver burden characterize a significant proportion of AD spousal caregivers. AD spousal caregivers also experience living bereavement as they experience profound feeling of grief analogous to what one experiences when a spouse dies. The chronic stress of spousal AD caregiving magnifies age- related changes in proinflammatory cytokines, an important predictor of morbidity and mortality. Mechanistically, chronic stress promotes desensitization of glucocorticoid receptors promoting glucocorticoid receptor resistance (GCR), which allows for elevated inflammation. Of course, not all AD spousal caregivers are at the same level of risk. However, research attempting to identify which AD spousal caregivers are at greatest risk is remarkably sparse. Out of the 173 studies examining the biological markers of physical health in relation to AD spousal caregivers, there is no work, to our knowledge, that examines how relationship and/or personality characteristics affect biological markers of physical health. Determining stable individual difference characteristics is critical to developing evidence-based treatments. Attachment theory is a useful framework for understanding individual differences in close relationships as well as how people cope with stressful life events. There are two patterns of attachment insecurity: attachment anxiety and attachment avoidance. People with high attachment anxiety use "hyperactivating" emotional coping strategies that accentuate the stress response. People with high attachment avoidance are uncomfortable depending on others and use "deactivating" coping strategies in an attempt to inhibit stress. This investigatory team demonstrated that compared with bereaved adults with low attachment anxiety, recently bereaved adults with higher attachment anxiety experienced more grief, more depressive symptoms, and elevated inflammation. Those who reported more grief had elevated levels of inflammation compared with those who reported less grief. Likewise, those who reported poorer QOL had higher levels of inflammation than those who reported better QOL. Our pilot work in AD spousal caregivers echoes these findings. We have also demonstrated that the association between attachment avoidance and health outcomes is moderated by high heart rate variability (HF-HRV), an important marker of aging, and emotion regulation (HF-HRV). We build upon our findings in bereaved adults to advance our understanding of which AD spousal caregivers are most vulnerable to the deleterious physical health effects of spousal dementia caregiving as they navigate the experience of living bereavement, while coping with the burden of caregiving and trying to maintain QOL. As an exploratory aim, we will examine how these individual differences in attachment orientation affect both members of the marital relationship.