Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Switzerland.
Department of Psychiatry, University of California San Diego, La Jolla.
J Gerontol A Biol Sci Med Sci. 2020 Oct 15;75(11):2215-2223. doi: 10.1093/gerona/glaa079.
This study examined whether biological mechanisms linking dementia caregiving with an increased risk of coronary heart disease can be modified by psychosocial interventions and which caregivers might benefit the most from an intervention.
Spousal dementia caregivers were randomized to 12-week treatment with either a behavioral activation intervention (ie, Pleasant Events Program [PEP]; n = 60), or an active control Information and Support (IS; n = 63) condition. Indicators of caregiving stress were assessed pretreatment and circulating cardiovascular biomarkers were measured pre- and posttreatment.
There were no significant changes in biomarker levels from pre- to posttreatment both by treatment condition and across all caregivers. Regardless of the treatment condition, exploratory regression analysis revealed that caregivers were more likely to show significant decreases in C-reactive protein (CRP) and D-dimer when their spouse had severe functional impairment; in interleukin (IL)-6 and CRP when they had greater distress due to care recipient's problem behaviors; in tumor necrosis factor (TNF)-α when they had higher levels of negative affect; and in IL-6, CRP, TNF-α, and D-dimer when they had higher personal mastery. Within the PEP group, caregivers with higher negative affect and those with higher positive affect were more likely to show a reduction in von Willebrand factor and D-dimer, respectively. Within the IS group, caregivers whose spouse had severe functional impairment were more likely to show a decrease in IL-6.
Unlike the average caregiver, caregivers high in burden/distress and resources might benefit from psychosocial interventions to improve cardiovascular risk, although these observations need confirmation.
本研究旨在探讨心理社会干预是否可以改变与痴呆症照料相关的冠心病风险增加的生物学机制，以及哪些照料者可能从干预中获益最多。
将配偶痴呆症照料者随机分为 12 周的行为激活干预组（即愉快事件计划[PEP]；n=60）或积极对照组（信息和支持[IS]；n=63）。在治疗前评估照料者的压力指标，并在治疗前和治疗后测量循环心血管生物标志物。
无论是治疗条件还是所有照料者，生物标志物水平在治疗前后均无显著变化。无论治疗条件如何，探索性回归分析表明，当配偶的功能严重受损时，照料者更有可能显著降低 C 反应蛋白（CRP）和 D-二聚体；当他们因照顾对象的行为问题而感到更大的痛苦时，白细胞介素（IL）-6 和 CRP 会降低；当他们的负面情绪较高时，肿瘤坏死因子（TNF）-α 会降低；当他们的个人掌控力较高时，IL-6、CRP、TNF-α 和 D-二聚体都会降低。在 PEP 组中，负面情绪较高和正面情绪较高的照料者更有可能分别降低血管性血友病因子和 D-二聚体。在 IS 组中，配偶功能严重受损的照料者更有可能降低 IL-6。
与一般照料者不同，负担/压力较大和资源较多的照料者可能会从心理社会干预中获益，以改善心血管风险，但这些观察结果需要进一步证实。
