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.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
5R01AG031090-05
Application #
8233385
Study Section
Psychosocial Risk and Disease Prevention Study Section (PRDP)
Program Officer
Nielsen, Lisbeth
Project Start
2008-04-01
Project End
2014-03-31
Budget Start
2012-04-01
Budget End
2014-03-31
Support Year
5
Fiscal Year
2012
Total Cost
$301,392
Indirect Cost
$106,316
Name
University of California San Diego
Department
Psychiatry
Type
Schools of Medicine
DUNS #
804355790
City
La Jolla
State
CA
Country
United States
Zip Code
92093
Mausbach, Brent T; Chattillion, Elizabeth A; Ho, Jennifer et al. (2014) Why does placement of persons with Alzheimer's disease into long-term care improve caregivers' well-being? Examination of psychological mediators. Psychol Aging 29:776-86
Ho, Jennifer S; Bordon, Jennifer; Wang, Vicki et al. (2014) Reduced activity restriction buffers the relations between chronic stress and sympathetic nervous system activation. J Gerontol B Psychol Sci Soc Sci 69:408-16
von Känel, Roland; Mausbach, Brent T; Ancoli-Israel, Sonia et al. (2014) Positive affect and sleep in spousal Alzheimer caregivers: a longitudinal study. Behav Sleep Med 12:358-72
Mausbach, Brent T; Chattillion, Elizabeth A; Roepke, Susan K et al. (2013) A comparison of psychosocial outcomes in elderly Alzheimer caregivers and noncaregivers. Am J Geriatr Psychiatry 21:5-13
Chattillion, Elizabeth A; Ceglowski, Jenni; Roepke, Susan K et al. (2013) Pleasant events, activity restriction, and blood pressure in dementia caregivers. Health Psychol 32:793-801
Moore, Raeanne C; Chattillion, Elizabeth A; Ceglowski, Jennifer et al. (2013) A randomized clinical trial of Behavioral Activation (BA) therapy for improving psychological and physical health in dementia caregivers: results of the Pleasant Events Program (PEP). Behav Res Ther 51:623-32
Irwin, Scott A; Mausbach, Brent T; Koo, Derek et al. (2013) Association between hospice care and psychological outcomes in Alzheimer's spousal caregivers. J Palliat Med 16:1450-4
Roepke, Susan K; Allison, Matthew; Von Kanel, Roland et al. (2012) Relationship between chronic stress and carotid intima-media thickness (IMT) in elderly Alzheimer's disease caregivers. Stress 15:121-9
Mausbach, Brent T; Roepke, Susan K; Chattillion, Elizabeth A et al. (2012) Multiple mediators of the relations between caregiving stress and depressive symptoms. Aging Ment Health 16:27-38
Roepke, Susan K; Chattillion, Elizabeth A; von Kanel, Roland et al. (2011) Carotid plaque in Alzheimer caregivers and the role of sympathoadrenal arousal. Psychosom Med 73:206-13

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