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

照顾阿尔茨海默病或相关痴呆症(ADRD)的配偶是生活中压力最大的事情之一 经历并以照顾者负担、悲伤以及较高的发病率和早产儿为特征 死亡率。然而，ADRD配偶照顾者的心理和身体上存在着相当大的不可解释的变异性 健康模式。ADRD配偶照顾者容易受到社会孤立和孤独，这两个独立但又相关的 被认为会加剧ADRD配偶照顾者身体和心理健康问题的结构。我们知道的很少 关于孤独、社会孤立以及它们的时间动态和互动如何在 在现实世界里。这是不幸的，因为痴呆症的配偶照顾者经历了客观的社会孤立 和孤独感，以及它们同时出现的生理状态，都在不断地实时变化 时间动态、最近瞬间因素(例如，位置、时间、任务/应激源、质量和 最近社交交互的类型)、关系期望、情绪和行为的类似特征的模式(例如， 依恋取向)和社会文化条件。由300名ADRD配偶组成的社会文化多样性队列 照顾者将回答有关他们的精神健康的问题(照顾者负担、抑郁和悲伤)，并提供 血液检测促炎症细胞因子和两种相关的炎症表型决定因素细胞 年龄、疾病(即线粒体和糖酵解功能)在基线和两次随访期间(2 基线后数周和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。 在第一次访问和第二次访问之间的两周间隔期间，为期14天的生态评估将提供有关 孤独感、抑郁情绪、瞬间环境(例如，当前位置、社会环境、日常活动、照顾 和非护理压力源。使用一款复杂的智能手表，我们成功地在ADRD配偶身上进行了试验 护理人员，我们将持续评估迷走神经调节的心率变异性。AIM 1模拟了瞬间 孤独感、抑郁情绪和迷走神经介导的心率变异性之间的关系；目标1也将 模拟孤独感(严重程度和变异性)对ADRD配偶照顾者心理指标的影响 幸福感(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)随时间推移。目标2调查短暂的孤独、ADRD配偶之间的联系 照顾者的心理健康和身体健康指数受瞬间情境的影响，并且相对稳定 个人内部(即依恋取向)和背景(即社会文化条件)因素的指数。目标 3(探索性)模拟vmHRV对ADRD配偶精神护理幸福感指数(照顾者)的影响 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.