Dementia of the Alzheimer's Type (DAT) is characterized by progressive cognitive/behavioral impairment. As DAT progresses the patient is less able to care for him/herself becoming more dependent on his/her caregiver (usually spouse). Increased cognitive/behavioral/affective decline in the patient may result in decreased mental/physical health in the spouse. Much needs to be learned about these dynamics. The vast majority of DAT research has concentrated on the patient or the caregiver, but not on both. We recognize the potential effect of DAT patients on the mental/physical health of their spouses. In this multidisciplinary longitudinal study, we will compare psychosocial, immunological, and cardiovascular distress, in 70 spouses of mild DAT patients to the distress in 70 age- sex- and health status-matched spouses of controls. The controls will occur twice, 15 months apart. We believe we can obtain the required samples in the proposed time by using both our DAT Roster and the community sampling procedures practiced in our current studies. Using a theoretical model of distress to guide our research, 4 hierarchical hypotheses will be tested: (1) initially and at follow-up DAT spouses will be more distressed than control spouses on all measures; (2) at follow-up DAT spouses will be more distressed than at baseline, whereas mean differences over time in control spouses partially explained by increases in DAT patient's cognitive/functional decline; however, these relationships will be modified by 3 spouse factors (life stressors, vulnerability, and resources); (4) biological and psychosocial distress will be more correlated at follow-up than at initial assessment; and at both times these relationships will be greater for vulnerable spouses (e.g., hostile/angry, etc.) and less for spouses with resources (e.g., social support and coping). The General Linear Model will be used to statistically test the hypotheses. This research will integrate psychosocial and biological sequelae of stress in DAT spouses and therefore shed light on ADAMHA priorities.

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National Institute of Mental Health (NIMH)
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Life Course and Prevention Research Review Committee (LCR)
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University of Washington
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Vitaliano, Peter P; Murphy, Michael; Young, Heather M et al. (2011) Does caring for a spouse with dementia promote cognitive decline? A hypothesis and proposed mechanisms. J Am Geriatr Soc 59:900-8
Vitaliano, Peter P (2010) An ironic tragedy: are spouses of persons with dementia at higher risk for dementia than spouses of persons without dementia? J Am Geriatr Soc 58:976-8
Vitaliano, Peter P; Katon, Wayne; Unutzer, Jurgen (2005) Making the case for caregiver research in geriatric psychiatry. Am J Geriatr Psychiatry 13:834-43
Vitaliano, Peter P; Echeverria, Diana; Yi, Joyce et al. (2005) Psychophysiological mediators of caregiver stress and differential cognitive decline. Psychol Aging 20:402-11
Vitaliano, Peter P; Persson, Rutger; Kiyak, Asuman et al. (2005) Caregiving and gingival symptom reports: psychophysiologic mediators. Psychosom Med 67:930-8
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Scanlan, J M; Vitaliano, P P; Ochs, H et al. (1998) CD4 and CD8 counts are associated with interactions of gender and psychosocial stress. Psychosom Med 60:644-53

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