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脆弱群体，由于压力增加，他们的身体和心理并发症风险增加。值得注意的是，报告心理压力的照顾者相对于非照顾者有更大的早逝风险，而无压力的照顾者则没有这种风险。死亡率增加、免疫力降低和抑郁症增加--所有这些都在阿尔茨海默病家庭成员的照顾者中发现--表明生活压力干扰了正常的生物衰老过程。 照顾者的心理症状也增加了痴呆症亲属的机构化风险。因此，至关重要的是要制定干预措施，可以降低照顾者的压力和减少抑郁症，并了解改善的神经机制。护理人员中央冥想和意象疗法（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。它被设计为一个简短的干预，以适应照顾者的忙碌的时间表。CMIT提供实用的放松和正念技巧，帮助个人安心，并改善参与者与痴呆症患者的亲人的观点。 这些好处结合在一起，可以增强照顾者随着年龄增长的心理和社会功能。 我们从一项小型的CMIT对照试验（N = 20）中获得了可行性数据，该试验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进行了研究，证明了CMIT相对于放松控制条件对减少照顾者抑郁的巨大影响，并在照顾者的一个子集（N = 8）中提供了CMIT可能影响大脑结构和功能变化的初步证据。有了这项R21补助金，我们将对50名抑郁症护理人员进行随机，对照，单盲试点临床试验，并获得神经成像，以确定护理人员相对于支持组的改善机制。我们假设，CMIT将有适度更大的影响，减少照顾者抑郁症比支持组，在CMIT的参与者，但不是支持组将证明大脑结构和功能的变化。这些假设将通过我们的具体目标进行检验：（1）相对于支持组，确定CMIT用于治疗患有阿尔茨海默病和相关痴呆的照顾者的抑郁症状的效应量，（2）识别与从干预前到干预后的改善相关的脑回路，（3）确定脑结构变化是否与CMIT 4周内照顾者抑郁的改善相关。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，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.