This study will use the chronic stress of caregiving as a natural experiment to examine relationships among psychobehavioral processes, race, the metabolic syndrome, and Coronary Heart Disease (CHD) that could not be ethically manipulated in a laboratory. Caregiving is associated with psychosocial (anger/hostility, hassles, depression) problems, which are, in turn, associated with metabolic, cardiovascular, and physical health problems. We have observed that insulin independently distinguishes spouse caregivers and controls (caregivers greater controls) better than other physiological variables and that caregivers greater controls on CHD prevalence. Accordingly, we will compare 130 spouse caregivers of persons with Alzheimer's disease (AD) (n=100 Caucasians, n=30 Blacks) to 130 spouses of non-demented controls matched on sex, race, age, and family history of cardiovascular disease. Assessments will occur at: Time 1, Time 2 (15-18 months after Time 1), and Time 3 (27-30 months after Time 1). We will focus on psychophysiological mediators to understand why chronic stress may increase metabolic problems and CHD in caregivers relative to controls. Our multiple measures will include: medical records (ICD-codes), physical exams, physiology and self reports. A biopsychosocial model will be used to examine 5 aims:
Aim 1 : To determine whether spouse caregivers of AD victims exhibit more: psychobehavioral, metabolic (greater intraabdominal fat (IAF), insulin, C-peptide, glucose), stress hormone (greater cortisol, catecholamines), plasma viscosity (greater hematocrit), and cardiovascular (greater blood pressure (BP) problems and higher rates of CHD relative to spouses of non-demented controls.
Aim 2 : To determine whether Blacks have greater problems than do Caucasians; and whether Black caregivers have greater problems than Caucasian caregivers.
Aim 3 : To determine whether BP differences in caregivers are greater at home than in the laboratory and whether race and psychosocial variables modify such differences.
Aim 4 : To determine whether psychophysiological changes in caregivers are greater when measured over a longer period (27-30 months) than we studied originally (15-18 months); and whether CHD at Time 1 amplifies these changes.
Aim 5 : To determine whether over 27-30 months, IAF trajectories are associated with changes in psychophysiological/health variables; and whether such relationships are mediated by insulin changes. This research should elucidate psychophysiological mediators of chronic stress and CHD and, therefore, have clinical implications.
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