Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, CH-3010 Bern, Switzerland.
J Gerontol A Biol Sci Med Sci. 2010 Sep;65(9):1004-11. doi: 10.1093/gerona/glq073. Epub 2010 May 19.
Low-grade hypercoagulability might be one pathway to explain how the chronic stress of dementia caregiving increases cardiovascular disease risk, but the specific aspects of caregiver stress that elicit hypercoagulability are elusive. We hypothesized that dementia patients' problem behaviors and negative reactions of caregivers to these behaviors would relate to hypercoagulability in caregivers.
One hundred and eight participants (mean age 74 +/- 8 years, 70% women) providing in-home care for their spouse with Alzheimer's disease were examined. Caregivers were interviewed about the number of 24 predefined patient problem behaviors in the previous week (range 0-24) and how upset or bothered they felt in response to these behaviors (total score 0-96). Von Willebrand factor, plasminogen activator inhibitor-1, and D-dimer were determined in plasma and standardized z-scores of their concentrations summed into a procoagulant index.
Greater number of problem behaviors (Delta R(2) = 0.046, p = .014) and negative reactions of caregivers to these behaviors (Delta R(2) = 0.044, p = .017) were associated with greater procoagulant index after controlling for sociodemographic factors, major cardiovascular risk factors, health habits, and health problems. However, the number of and reaction to problem behaviors did not significantly predict procoagulant activity independent from each other. Post hoc analysis revealed a positive association between the number of problem behaviors and D-dimer (p = .010, Delta R(2) = 0.053), even when controlling for negative reactions (p = .033, Delta R(2) = 0.036). Caregiver reaction to problem behaviors was not significantly associated with any procoagulant factor individually.
Alzheimer patients' problem behavior and their negative appraisal by the caregiver may contribute to the chronic low-grade hypercoagulable state in dementia caregivers.
轻度高凝状态可能是解释痴呆症照料者的慢性压力如何增加心血管疾病风险的途径之一，但引起照料者高凝状态的具体压力方面仍难以捉摸。我们假设痴呆症患者的问题行为以及照料者对这些行为的负面反应与照料者的高凝状态有关。
我们对 108 名（平均年龄 74 +/- 8 岁，70%为女性）为其患有阿尔茨海默病的配偶提供家庭护理的参与者进行了检查。照料者接受了关于在过去一周内出现的 24 种预先确定的患者问题行为的数量（范围 0-24）以及他们对这些行为的反应有多沮丧或烦恼的访谈（总分为 0-96）。在血浆中测定了血管性血友病因子、纤溶酶原激活物抑制剂-1 和 D-二聚体，并将其浓度的标准化 z 分数相加得出促凝指数。
在控制社会人口因素、主要心血管危险因素、健康习惯和健康问题后，更多的问题行为（Delta R(2) = 0.046，p =.014）和照料者对这些行为的负面反应（Delta R(2) = 0.044，p =.017）与更大的促凝指数相关。然而，问题行为的数量和对问题行为的反应并不能独立于彼此显著预测促凝活性。事后分析显示，即使在控制负面反应的情况下（p =.033，Delta R(2) = 0.036），问题行为的数量与 D-二聚体之间也存在正相关（p =.010，Delta R(2) = 0.053）。照料者对问题行为的反应与任何促凝因子均无显著相关性。
阿尔茨海默病患者的问题行为及其对患者的负面评价可能导致痴呆症照料者慢性轻度高凝状态。
