In this competing renewal we request five years of support to continue our inquiry into adaptation and health outcomes among Alzheimer caregivers (CG). Our major hypotheses are: 1) that the chronic stress of caregiving will be reflected in physiologic measures of activation - altered hypothalmic-pituitary-adrenal (HPA) axis sensitivity, increased sympathoadrenal medullary (SAM) activity, and reduced natural killer (NK) cell activity; and 2) that over time those CG with highest caregiver stress will show the most significant physiological alterations which will be predictive of worsening CG health. The research is guided by a conceptual model which postulates that to understand the effect of stressors on CG health we must consider the influence of certain mediators and background characteristics. Stressors can be patient-derived (dementia, problem behaviors, help required) or environmental (life events) leading to CG role overload. Mediators are interpersonal (supports) and intrapersonal (self-concept, coping activity). Background characteristics include age, gender socioeconomic status, and past health. The outcomes of caregiving are conceptualized at 3 levels: physiologic (HPA alteration., SAM activation, NK activity), psychologic (anxiety, depression), and physical (symptoms, illness episodes). The study has two components. In the """"""""field"""""""" study 200 spousal CG and 80 noncaregiving controls (NC) will be examined every 6 months for 5 years. Data will be gathered on state and needs of the patient, life stresses, resources, supports, medical events, and psychological state of CG. Blood samples for NK, cortisol, ACTH, norepinephrine, epinephrine and neuropeptide Y will be drawn in the CG home during a blood pressure postural reactivity protocol. Nested in the field study is our 'laboratory' study which will, for the first time, attempt to probe HPA axis sensitivity and SAM activation in CG experiencing varying levels of caregiver stress. Here we shall perform corticotropin releasing factor (CRF) infusion studies, as well as sympathetic reactivity studies with 60 CG and 30 NC """"""""selected"""""""" to be free of major medical confounds (including medications). The data from this phase should move caregiver research closer to understanding mechanisms linking caregiver stress, physiological response, and health.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
3R01AG015301-11S1
Application #
6146002
Study Section
Mental Disorders of Aging Review Committee (MDA)
Project Start
1997-09-30
Project End
2001-08-31
Budget Start
1999-09-30
Budget End
2000-08-31
Support Year
11
Fiscal Year
1999
Total Cost
Indirect Cost
Name
University of California San Diego
Department
Psychiatry
Type
Schools of Medicine
DUNS #
077758407
City
La Jolla
State
CA
Country
United States
Zip Code
92093
Mausbach, Brent T; Romero-Moreno, Rosa; Bos, Taylor et al. (2017) Engagement in Pleasant Leisure Activities and Blood Pressure: A 5-Year Longitudinal Study in Alzheimer Caregivers. Psychosom Med 79:735-741
Wu, Kevin K; Bos, Taylor; Mausbach, Brent T et al. (2017) Long-term caregiving is associated with impaired cardiovagal baroreflex. J Psychosom Res 103:29-33
von Känel, Roland (2015) ACUTE MENTAL STRESS AND HEMOSTASIS: WHEN PHYSIOLOGY BECOMES VASCULAR HARM. Thromb Res 135:S52-S55
von Känel, Roland (2015) Acute mental stress and hemostasis: When physiology becomes vascular harm. Thromb Res 135 Suppl 1:S52-5
von Känel, Roland; Mausbach, Brent T; Mills, Paul J et al. (2014) Longitudinal relationship of low leisure satisfaction but not depressive symptoms with systemic low-grade inflammation in dementia caregivers. J Gerontol B Psychol Sci Soc Sci 69:397-407
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
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
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
Schwartz, Jennifer; Allison, Matthew A; Ancoli-Israel, Sonia et al. (2013) Sleep, type 2 diabetes, dyslipidemia, and hypertension in elderly Alzheimer's caregivers. Arch Gerontol Geriatr 57:70-7
Nguyen, Anh; Rossi, Steven; Croteau, David et al. (2013) Etravirine in CSF is highly protein bound. J Antimicrob Chemother 68:1161-8

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