Individual differences in dementia spousal caregiver burden: A biobehavioral approach

痴呆症配偶照顾者负担的个体差异：生物行为方法

• 批准号: 10617191
• 负责人: Christopher Paul Fagundes
• 金额: $ 74.57万
• 依托单位: RICE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-06-15 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10617191
• 关键词: Adult; Affect; Aging; Alzheimer' s Disease; Alzheimer' s disease care; Alzheimer' s disease patient; Alzheimer' s disease risk; Anxiety; Bereavement; Biological Markers; Blood; Caregiver Burden; Caregiver well-being; Caregivers; Characteristics; Chronic stress; Coping Skills; Couples; Data; Dementia; Disease; Emotional; Evidence based treatment; Exhibits; Feeling; Glucocorticoid Receptor; Grief reaction; Health; Immune; Individual Differences; Inflammation; Inflammatory; Intervention; Interview; Knowledge; Marital Relationships; Mental Health; Modeling; Morbidity - disease rate; Outcome; Pattern; Personality Character; Persons; Quality of life; Reporting; Research; Research Design; Research Personnel; Resistance; Risk; Scientist; Spouse Caregiver; Spouses; Stress; Stressful Event; Symptoms; Work; age related; anxious; biobehavior; biological adaptation to stress; care giving burden; caregiving; coping; cytokine; dementia caregiving; depressive symptoms; desensitization; emotion regulation; experience; heart rate variability; member; mortality; physical conditioning; prospective; psychosocial; theories; treatment planning

Project Summary/ Abstract Caregiving for a spouse with Alzheimer’s Disease (AD) is one of the most stressful experiences a person can encounter. Among married couples when one member of the dyad has AD, the disease is often described as a relational illness because every aspect of the disease necessarily involves the spouse. Poor quality of life (QOL) and caregiver burden characterize a significant proportion of AD spousal caregivers. AD spousal caregivers also experience living bereavement as they experience profound feeling of grief analogous to what one experiences when a spouse dies. The chronic stress of spousal AD caregiving magnifies age- related changes in proinflammatory cytokines, an important predictor of morbidity and mortality. Mechanistically, chronic stress promotes desensitization of glucocorticoid receptors promoting glucocorticoid receptor resistance (GCR), which allows for elevated inflammation. Of course, not all AD spousal caregivers are at the same level of risk. However, research attempting to identify which AD spousal caregivers are at greatest risk is remarkably sparse. Out of the 173 studies examining the biological markers of physical health in relation to AD spousal caregivers, there is no work, to our knowledge, that examines how relationship and/or personality characteristics affect biological markers of physical health. Determining stable individual difference characteristics is critical to developing evidence-based treatments. Attachment theory is a useful framework for understanding individual differences in close relationships as well as how people cope with stressful life events. There are two patterns of attachment insecurity: attachment anxiety and attachment avoidance. People with high attachment anxiety use "hyperactivating" emotional coping strategies that accentuate the stress response. People with high attachment avoidance are uncomfortable depending on others and use "deactivating" coping strategies in an attempt to inhibit stress. This investigatory team demonstrated that compared with bereaved adults with low attachment anxiety, recently bereaved adults with higher attachment anxiety experienced more grief, more depressive symptoms, and elevated inflammation. Those who reported more grief had elevated levels of inflammation compared with those who reported less grief. Likewise, those who reported poorer QOL had higher levels of inflammation than those who reported better QOL. Our pilot work in AD spousal caregivers echoes these findings. We have also demonstrated that the association between attachment avoidance and health outcomes is moderated by high heart rate variability (HF-HRV), an important marker of aging, and emotion regulation (HF-HRV). We build upon our findings in bereaved adults to advance our understanding of which AD spousal caregivers are most vulnerable to the deleterious physical health effects of spousal dementia caregiving as they navigate the experience of living bereavement, while coping with the burden of caregiving and trying to maintain QOL. As an exploratory aim, we will examine how these individual differences in attachment orientation affect both members of the marital relationship.

项目概要/摘要 照顾患有阿尔茨海默病 (AD) 的配偶是最有压力的经历之一 在已婚夫妇中，当二人中的一名成员患有 AD 时，这种疾病通常会发生。 被描述为一种关系性疾病，因为这种疾病的各个方面都必然涉及到配偶。 生活质量 (QOL) 和照顾者负担是 AD 配偶照顾者中很大一部分的特征。 配偶照顾者也会经历生活中的丧亲之痛，因为他们会经历类似的深刻悲伤感 配偶去世时的经历 配偶 AD 照顾的长期压力会放大年龄。 促炎细胞因子的相关变化，是发病率和死亡率的重要预测因子。 从机制上讲，慢性应激促进糖皮质激素受体脱敏，从而促进糖皮质激素 受体抵抗 (GCR)，这会导致炎症升高 当然，并非所有 AD 配偶照顾者都会出现这种情况。 然而，研究试图确定哪些 AD 配偶照顾者处于相同的风险水平。 在检查身体健康的生物标志物的 173 项研究中，最大的风险却出奇地少。 就 AD 配偶照顾者而言，据我们所知，没有任何工作能够检验关系和/或 人格特征影响身体健康的生物标志物，决定稳定的个体差异。 依恋理论是一个有用的框架 了解亲密关系中的个体差异以及人们如何应对生活压力 依恋不安全感有两种模式：依恋焦虑和依恋回避。 患有高度依恋焦虑的人会使用“过度活跃”的情绪应对策略来加剧压力 依恋回避程度高的人对依赖他人和使用感到不舒服。 “停用”应对策略以试图抑制压力。该调查小组证明了这一点。 与依恋焦虑程度较低的丧亲者成年人相比，依恋程度较高的近期丧亲者成年人 那些报告焦虑的人会经历更多的悲伤、更多的抑郁症状和更高的炎症。 与那些悲伤较少的人相比，更多悲伤的人炎症水平更高。 那些报告生活质量较差的人比那些报告生活质量较好的人有更高的炎症水平。 AD 配偶照顾者的工作与这些发现相呼应，我们也证明了这种关联。 高心率变异性 (HF-HRV) 可以调节依恋回避与健康结果之间的关系， 我们基于对失去亲人的成年人的研究结果来确定衰老和情绪调节（HF-HRV）的重要标志。 增进我们对哪些 AD 配偶照顾者最容易受到有害身体伤害的了解 配偶痴呆症护理对健康的影响，因为他们经历了丧亲之痛，同时 作为探索性目标，我们将研究如何应对护理负担并努力维持生活质量。 这些依恋取向的个体差异影响着婚姻关系的双方。

项目成果

Trajectories of depressive symptoms early in the course of bereavement: Patterns, psychosocial factors and risk of prolonged grief.

丧亲之痛早期抑郁症状的轨迹：模式、心理社会因素和长期悲伤的风险。

• 发表时间: 2023-11-05
• 作者: Majd, Marzieh;Chen, Michelle A;Chirinos, Diana A;Brown, Ryan L;LeRoy, Angie S;Murdock, Kyle W;Wu;Thayer, Julian F;Fagundes, Christopher P
• 通讯作者: Fagundes, Christopher P

Employment and family income in psychological and immune outcomes during bereavement.

丧亲期间的就业和家庭收入对心理和免疫结果的影响。

• 发表时间: 2023-04
• 影响因子: 3.7
• 作者: Paoletti, Jensine;Chen, Michelle A;Wu;Brown, Ryan L;LeRoy, Angie S;Murdock, Kyle W;Heijnen, Cobi J;Fagundes, Christopher P
• 通讯作者: Fagundes, Christopher P

Spousal caregiving, widowhood, and cognition: A systematic review and a biopsychosocial framework for understanding the relationship between interpersonal losses and dementia risk in older adulthood.

配偶照顾、丧偶和认知：系统回顾和生物心理社会框架，用于理解老年时期人际损失和痴呆风险之间的关系。

• 发表时间: 2022-03
• 影响因子: 8.2
• 作者: Wu;Leal, Stephanie L;Denny, Bryan T;Cheng, Samantha L;Fagundes, Christopher P
• 通讯作者: Fagundes, Christopher P

Deep learning to predict rapid progression of Alzheimer's disease from pooled clinical trials: A retrospective study.

从汇总临床试验中预测阿尔茨海默病快速进展的深度学习：一项回顾性研究。

• 发表时间: 2024-04
• 作者: Ma, Xiaotian;Shyer, Madison;Harris, Kristofer;Wang, Dulin;Hsu, Yu;Farrell, Christine;Goodwin, Nathan;Anjum, Sahar;Bukhbinder, Avram S;Dean, Sarah;Khan, Tanveer;Hunter, David;Schulz, Paul E;Jiang, Xiaoqian;Kim, Yejin
• 通讯作者: Kim, Yejin

Childhood maltreatment, subjective social status, and health disparities in bereavement.

童年虐待、主观社会地位以及丧亲之痛中的健康差异。

• 发表时间: 2022-01
• 影响因子: 3.7
• 作者: Chen, Michelle A;Brown, Ryan L;Chen, Jonathan Y;de Dios, Marcel A;Green, Charles E;Heijnen, Cobi J;Fagundes, Christopher P
• 通讯作者: Fagundes, Christopher P