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.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
Project #
Application #
Study Section
Mental Disorders of Aging Review Committee (MDA)
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of California San Diego
Schools of Medicine
La Jolla
United States
Zip Code
Mills, Paul J; Adler, Karen A; Dimsdale, Joel E et al. (2004) Vulnerable caregivers of Alzheimer disease patients have a deficit in beta 2-adrenergic receptor sensitivity and density. Am J Geriatr Psychiatry 12:281-6
von Kanel, Roland; Dimsdale, Joel E; Patterson, Thomas L et al. (2003) Acute procoagulant stress response as a dynamic measure of allostatic load in Alzheimer caregivers. Ann Behav Med 26:42-8
von Kanel, Roland; Dimsdale, Joel E; Patterson, Thomas L et al. (2003) Association of negative life event stress with coagulation activity in elderly Alzheimer caregivers. Psychosom Med 65:145-50
Adler, Karen A; Mills, Paul J; Dimsdale, Joel E et al. (2002) Temporal stability of acute stress-induced changes in leukocyte subsets and cellular adhesion molecules in older adults. Brain Behav Immun 16:262-74
Shaw, W S; Patterson, T L; Semple, S J et al. (2000) Use of community support services by middle-aged and older patients with psychotic disorders. Psychiatr Serv 51:506-12
Mills, P J; Yu, H; Ziegler, M G et al. (1999) Vulnerable caregivers of patients with Alzheimer's disease have a deficit in circulating CD62L- T lymphocytes. Psychosom Med 61:168-74
Kerner, D N; Patterson, T L; Grant, I et al. (1998) Validity of the Quality of Well-Being Scale for patients with Alzheimer's disease. J Aging Health 10:44-61
Patterson, T L; Semple, S J; Shaw, W S et al. (1998) The cultural context of caregiving: a comparison of Alzheimer's caregivers in Shanghai, China and San Diego, California. Psychol Med 28:1071-84
Shaw, W S; Patterson, T L; Semple, S J et al. (1997) Longitudinal analysis of multiple indicators of health decline among spousal caregivers. Ann Behav Med 19:101-9
Mills, P J; Ziegler, M G; Patterson, T et al. (1997) Plasma catecholamine and lymphocyte beta 2-adrenergic receptor alterations in elderly Alzheimer caregivers under stress. Psychosom Med 59:251-6

Showing the most recent 10 out of 11 publications