APC Microbiome Institute, Biosciences Institute, University College Cork, Cork, Ireland; Department of Psychiatry & Neurobehavioural Science, University College Cork, Cork, Ireland.
The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland; Department of Epidemiology & Public Health, University College Cork, Cork, Ireland.
Neurosci Biobehav Rev. 2017 Feb;73:123-164. doi: 10.1016/j.neubiorev.2016.12.006. Epub 2016 Dec 13.
As the physiological impact of chronic stress is difficult to study in humans, naturalistic stressors are invaluable sources of information in this area. This review systematically evaluates the research literature examining biomarkers of chronic stress, including neurocognition, in informal dementia caregivers. We identified 151 papers for inclusion in the final review, including papers examining differences between caregivers and controls as well as interventions aimed at counteracting the biological burden of chronic caregiving stress. Results indicate that cortisol was increased in caregivers in a majority of studies examining this biomarker. There was mixed evidence for differences in epinephrine, norepinephrine and other cardiovascular markers. There was a high level of heterogeneity in immune system measures. Caregivers performed more poorly on attention and executive functioning tests. There was mixed evidence for memory performance. Interventions to reduce stress improved cognition but had mixed effects on cortisol. Risk of bias was generally low to moderate. Given the rising need for family caregivers worldwide, the implications of these findings can no longer be neglected.
由于慢性压力对生理的影响在人类身上难以研究，因此自然压力源是该领域极具价值的信息来源。本综述系统地评估了研究文献，这些文献检查了非正式痴呆症护理者的慢性压力生物标志物，包括神经认知。我们确定了 151 篇论文纳入最终综述，包括检查护理者与对照组之间差异的论文，以及旨在抵消慢性护理压力生物学负担的干预措施。结果表明，在大多数检查这种生物标志物的研究中，皮质醇在护理者中增加。关于肾上腺素、去甲肾上腺素和其他心血管标志物的差异存在混合证据。免疫系统指标的异质性很高。护理者在注意力和执行功能测试中的表现较差。关于记忆表现存在混合证据。减少压力的干预措施改善了认知，但对皮质醇的影响存在差异。偏倚风险通常为低至中度。鉴于全球对家庭护理者的需求不断增加，这些发现的影响再也不能被忽视。
