Reducing CVD Risk in Caregivers: A Brief Behavioral Activation Intervention

描述(申请人提供)：由于社会老龄化，预计未来20年，被诊断为痴呆症的人数将大幅增加，为亲人提供非正式护理的家庭成员数量也随之增加。与这种护理相关的压力已经在科学文献中得到了很好的记录，并被注意到与心理和身体疾病，特别是心血管疾病的风险增加有关。事实上，照料与消极情绪(例如抑郁和焦虑症状)的升高有关，而负面情绪又与被认为可以预测心血管疾病风险的生物指标(例如凝血、内皮损伤或炎症的标志)相关。这项研究的主要目标是检查一种名为Pleasant Events Program(PEP)的简短行为激活治疗(BAT)在降低配偶阿尔茨海默病照顾者样本中生物CVD风险指标方面的有效性。我们还将检查这种干预是否成功地改变了交感肾上腺髓质(SAM)的激活，这是将应激和影响与CVD风险生物标志物联系起来的一种机制。我们将招募100名痴呆症护理人员，并随机分配他们接受4次PEP或4次支持+信息。我们的PEP干预将在照顾者的家中进行，并将强调监测和增加活动的重要性，帮助个人与其环境中的天然增强剂接触，识别和减少负面应对反应，以及选择和实现更健康生活的行为目标。照顾者将在基线、6周和12周时接受生物学结果评估，以确定干预效果。考虑到PEP干预的简洁性，它可以很容易地应用于现实世界的环境(例如，社区机构为照顾者提供服务)，以及干预者和照顾者缺乏困难的技能，我们相信我们的PEP干预将很容易地转移到“真实世界”的环境中。如果我们的PEP干预是有效的，它可能会对照顾者的身心健康产生相当大的影响，并可能对公共卫生产生影响。 公共卫生相关性：心血管疾病和抑郁症是社会代价最高的疾病之一，照顾患有阿尔茨海默病的亲人会增加患抑郁症和心血管疾病的风险。事实上，抑郁症状与血浆D-二聚体、白介素6(IL-6)和血管性血友病因子(VWF)浓度升高有关，所有这些都与心血管疾病(CVD)的风险增加有关。目前的研究测试了一种简短的行为干预，以减少阿尔茨海默病照顾者的抑郁症状和心血管疾病生物标记物。如果成功，这种干预可能有助于改善这一人群的整体身心健康，可以很容易地实施到以社区为基础的组织中，并最终减少这些疾病对照顾者和社会的影响。

DESCRIPTION (provided by applicant): Due to an aging society, the number of people diagnosed with dementia is expected to increase dramatically over the next two decades, with a concomitant rise in the number of family members providing informal care for their loved ones. The stresses associated with this care have been well-documented in the scientific literature, and are noted to be associated with increased risk for psychological and physical morbidity, particularly cardiovascular disease. Indeed, caregiving is associated with elevations in negative affect (e.g., depressive and anxiety symptoms), which in turn is associated with biological indicators that are thought to predict CVD risk (e.g., markers of coagulation, endothelial injury, or inflammation). The primary goal of this study is to examine the efficacy of a brief Behavioral Activation Treatment (BAT), called the Pleasant Events Program (PEP), for reducing biological CVD risk indicators in a sample of spousal Alzheimer caregivers. We will also examine whether this intervention is successful for modifying Sympathoadrenal Medullary (SAM) activation, which is one mechanism linking stress and affect to CVD risk biomarkers. We will enroll 100 dementia caregivers and randomly assign them to receive 4-sessions of PEP or 4-sessions of support + information. Our PEP intervention will be conducted in caregivers' homes and will emphasize the importance of monitoring and increasing activities that help individuals make contact with natural reinforcers in their environments, identifying and reducing negative coping responses, and selection and achievement of behavioral goals for healthier living. Caregivers will be assessed for our biological outcomes at baseline, 6-, and 12-weeks to determine intervention efficacy. Given the brief nature of the PEP intervention, the ease with which it can be applied in real-world settings (e.g., community agencies providing services to caregivers), and lack of difficult skills for interventionists and caregivers to acquire, we believe our PEP intervention will be easily transferred to "real-world" settings. If our PEP intervention is efficacious, it may have a considerable impact on both the physical and mental health of caregivers, and will likely have public health implications. Public Health Relevance: Cardiovascular disease and depression are some of the most costly illnesses to society, and caring for a loved-one with Alzheimer's disease has been associated with increased risk for both depression and cardiovascular disease. Indeed, depressive symptoms have been linked with elevated plasma concentrations of D-dimer, Interleukin-6 (IL-6), and von Willebrand Factor (vWF), all of which are associated with increased risk for cardiovascular disease (CVD). The present research tests a brief behavioral intervention for reducing both depressive symptoms and CVD biomarkers in Alzheimer caregivers. If successful, this intervention may help improve overall physical and mental health in this population, can be easily implemented into community-based organizations, and ultimately reduce the impact of these conditions on caregivers and society.