STRESS IN ALZHEIMERS PATIENT-SPOUSE INTERACTIONS

阿尔茨海默型痴呆(DAT)的特点是进行性 认知/行为障碍。随着DAT的进展，患者越来越少 能够照顾他/她自己，变得更加依赖他/她的照顾者 (通常是配偶)。随着时间的推移，患者变得更加受限于 家庭环境和照顾者/配偶的心理社会环境。 因此，患者的功能可能会越来越多地反映 他/她的配偶。同时，通过反馈循环，增加了 患者的认知/行为下降可能会导致 配偶的社会心理障碍。这种恶性循环可能会导致 由于神经元变性，患者的病情下降远远超过了这一点。 不幸的是，需要对这些动态有很多了解：巨大的 大多数DAT研究都集中在患者或照顾者身上， 但不是两个都有。 在这项研究中，将检查纵向关系，以评估 配偶变量对轻度DAT患者(目标1)和轻度DAT的重要性 患者变量对配偶的影响(目标2)：1)进行初始和/或随访 心理社会中的配偶变量解释了随访中的差异 患者的认知/行为功能超出预期 患者最初的认知/行为功能？2)最初 和/或患者的后续认知/行为功能 超出预期的后续心理社会配偶变量的方差 从最初的心理社会配偶变量？一种两波随诊的设计 将使用：患者/配偶将在进入 老年及家庭服务诊所。后续评估将是 在各自的初步评估后18个月进行。标准 纳入的患者将是：DSM III诊断的原发性退行性变 痴呆(无混合性痴呆)，轻度(早期)阿尔茨海默病， 配偶是照顾者，并且居住在一小时车程内 西雅图。根据这4个标准，初始/后续数据将在 90个二元。为了达到这些目标，将使用分层回归。 输入的变量将反映压力/痛苦的理论模型 包括压力源、资源、脆弱性和苦恼。这项研究 将阐明ADAMHA的两个优先事项：家庭的互动 应激、应对与DAT的管理与心理社会因素 塑造和维持DAT患者积极行为的环境。

Dementia of the Alzheimer's Type (DAT) is characterizd by progressive cognitive/behavioral impairment. As DAT progresses the patient is less able to care for him/herself, becoming more dependent on his/her caregiver (usually spouse). Over time the patient becomes more restricted to the home environment and the psychosocial environment of the caregiver/spouse. As such, the patient's functioning may increasingly reflect the functioning of his/her spouse. Simultaneously, via feedback loops, increased cognitive/behavioral decline in the patient may result in increased psychosocial impairment in the spouse. This vicious cycle may lead to patient decline well beyond that due to neuronal degeneration. Unfortunately, much needs to be learned about these dynamics: The vast majority of DAT research has concentrated on the patient or the caregiver, but not on both. In this study longitudinal relationships will be examined to assess the importance of spouse variables on mild DAT patients (Aim 1) and mild DAT patient variables on spouses (Aim 2): 1) Do initial and/or follow-up psychosocial spouse variables account for variance in follow-up cognitive/behavioral functioning of patients beyond that expected from initial cognitive/behavioral functioning of patients? 2) Does initial and/or follow-up cognitive/behavioral functioning of patients account for variance in follow-up psychosocial spouse variables beyond that expected from initial psychosocial spouse variables? A two wave follow-up design will be used: patients/spouses will be first assessed at entry into the Geriatric and Family Services Clinic. Follow-up assessments will be performed 18 months after the respective initial assessments. Criteria for patient inclusion will be: DSM III diagnosis of Primary Degenerative Dementia (no mixed dementias), mild (early) stage of AD, living with one's spouse who is the caregiver, and living within one hour's drive of Seattle. Given these 4 criteria initial/follow-up data will be obtained on 90 dyads. Hierarchical regression will be used to meet the aims. Variables entered will reflect a theoretical model of stress/distress which involves stressors, resources, vulnerability and distress. This research will shed light on two ADAMHA priorities: The interaction of family stress, coping and the management of DAT, and factors in the psychosocial environment that shape and maintain positive behavior in DAT patients.