Mindfulness and guided imagery for depressed family caregivers of patients with Alzheimer’s disease and related dementias: clinical outcomes and neural mechanisms

阿尔茨海默病和相关痴呆症患者的家庭照顾者是一个易受伤害的群体，由于压力增加，他们的身体和心理并发症的风险增加。值得注意的是，与非照顾者相比，报告心理压力的照顾者早期死亡的风险更大，而没有压力的照顾者则没有这种风险。死亡率增加，免疫力下降，抑郁增加——所有这些都在患有阿尔茨海默病的家庭成员的照顾者身上发现——表明照顾压力干扰了正常的生物衰老过程。照顾者的心理症状也会增加痴呆症患者住院的风险。因此，开发干预措施，降低照顾者的压力，减少抑郁，并了解改善的神经机制是至关重要的。中央冥想和意象治疗（CMIT）是一项为期4周的团体正念和引导意象团体治疗干预，旨在减少抑郁和压力等负面心理症状，促进健康老龄化。它被设计成一个简短的干预，以适应照顾者繁忙的日程安排。CMIT提供了实用的放松和正念技巧，帮助个人平静的心态，也提高了与参与者所爱的痴呆症患者的观点。这些好处加在一起可能会增强照顾者随着年龄增长的心理和社会功能。我们从一项针对患有阿尔茨海默病和相关痴呆症的家庭成员的抑郁照顾者的小型对照试验（N = 20）中获得了可行性数据，该试验表明，相对于放松控制条件，CMIT在减少照顾者抑郁方面有很大的效果，并在一小部分照顾者（N = 8）中提供了CMIT可能影响大脑结构和功能改变的初步证据。在R21资助下，我们将对50名抑郁症护理人员进行随机、对照、单盲的试点临床试验，并获得神经影像学数据，以确定护理人员相对于支持小组的改善机制。我们假设，与支持小组相比，CMIT在减少照顾者抑郁方面的作用要大一些，并且CMIT参与者的大脑结构和功能会发生变化，而支持小组则不会。这些假设将通过我们的具体目标进行验证：(1)确定CMIT治疗阿尔茨海默病和相关痴呆护理者抑郁症状的效应大小，(2)确定干预前后与改善相关的脑回路，(3)确定4周以上CMIT治疗后，大脑结构变化是否与护理者抑郁改善相关。这些实验可能有助于建立一种新的、简短的治疗照顾者抑郁症的方法，并了解改善的神经机制，以帮助指导未来的研究。

Family caregivers of patients with Alzheimer’s disease and related dementias are a vulnerable population at increased risk of physical and psychological complications due to increased stress. Notably, caregivers who report psychological stress are at a greater risk of early death relative to non-caregivers, whereas unstressed caregivers do not share this risk. Increased mortality, lower immunity, and increased depression – all of which are found in caregivers of family members with Alzheimer’s disease – indicate that caregiving stress interferes with the process of normal biological aging. Psychological symptoms in caregivers also increase the risk of institutionalization of the relative with dementia. It is therefore crucial to develop interventions that can lower caregiver stress and reduce depression, and to understand neural mechanisms of improvement. Central Meditation and Imagery Therapy for Caregivers (CMIT) is a 4-week group mindfulness and guided imagery group therapy intervention that aims to reduce negative psychological symptoms such as depression and stress, and promote healthy aging. It was designed as a brief intervention to fit with caregivers’ busy schedules. CMIT provides practical relaxation and mindfulness techniques that aid with individual peace of mind, and also improve perspective taking with participants’ loved ones with dementia. These benefits combined may bolster caregivers’ mental and social functioning as they age. We obtained feasibility data from a small, controlled trial of CMIT (N = 20) with depressed caregivers of family members with Alzheimer’s disease and related dementias, that demonstrated a large effect of CMIT relative to a relaxation control condition on reducing caregiver depression, and provided preliminary evidence in a subset of caregivers (N = 8) that CMIT may effect structural and functional brain changes. With this R21 grant, we will conduct a randomized, controlled, single-blind pilot clinical trial of 50 depressed caregivers, and obtain neuroimaging to determine mechanisms of caregiver improvement relative to a support group. We hypothesize that CMIT will have moderately greater effects on reducing caregiver depression than a support group, and that participants in CMIT but not the support group will demonstrate changes in brain structure and function. These hypotheses will be tested with our Specific Aims: (1) Determine an effect size of CMIT for the treatment of depression symptoms in caregivers with Alzheimer’s disease and related dementias relative to a support group, (2) Identify brain circuits that correlate with improvement from pre to post intervention, (3) Determine whether structural brain changes are associated with improvement of caregiver depression with CMIT over 4 weeks. These experiments may help to establish a new, brief therapy for caregiver depression and understand neural mechanisms of improvement to help guide future research.