With the aging of the US population, the burden of Alzheimer's Disease (AD) has grown, and with it, the number of elderly spousal caregivers (CG) who provide frontline support and care for their AD spouse. The burden of care giving is associated with adverse psychological and general health consequences for the CG, including hazard for depression, cardiovascular disease, and earlier mortality. Our prior research has identified some possible mechanisms of cardiovascular risk in CG: these include negative effect, sleep disturbance, sympathoadrenal medullary (SAM) arousal, which are themselves linked to risk of hypertension, and indicators of vascular disease such as endothelial dysfunction (reduced flow mediated dilation [FMD]), increased intima- media thickness (IMT), reduced arterial compliance (AC), reduced baroreflex sensitivity (BRS), and increased carotid plaque. Because preliminary work has demonstrated that an easily taught and implemented technique - Behavioral Activation (BA) - reduces the negative affect associated with care giving, we wish in this continuing phase of our research to determine whether BA, in addition to improving mood, can also modify patho-physiological changes that have been linked to the hazard of cardiovascular disease.
Our aims are to determine whether a 6-week BA intervention, followed by 3 booster sessions over a period of 6 months, compared to an Information-Support (IS) intervention will be associated 1) With significant improvement in indicators of vascular pathology (i.e. flow mediated dilation, arterial compliance, intima medial thickness, and baroreflex sensitivity);and 2) With modification of psychobiological markers that have been associated with cardiovascular parameters, i.e., in sleep and negative affect;circulating biomarkers of hemostatic shift [D-dimer, Plasminogen Activator Inhibitor-1 antigen (PAI-1)], endothelial activation [von Willebrand Factor (vWF)], inflammation [C-reactive protein (CRP), Interleukin-6 (IL-6), Tumor necrosis factor- alpha (TNF-?)], and SAM arousal (urinary epinephrine and norepinephrine excretion);and to determine 3) Whether improvements in indicators of vascular parameters will be mediated by treatment related change in measures of distress and markers of cardiovascular disease risk. We will randomize 200 spousal CG (>55 years old), providing care at home, to the two treatment conditions-Behavioral Activation (BA) or information support (IS). Continuing with our model of deploying the research laboratory in the home, interventions and psychobiological measures will take place in the CG residence, to improve ecological validity. After the 6-week active intervention, and following the 6 months of 3 booster sessions, we will continue following participants for 2 years to determine long-term consolidation of any benefits. The study is innovative in its focus on potential effects of BA on physiological indicators of vascular risk, and promises an approach to preventing CG morbidity and mortality through a method that can be easily implemented in the field.

Public Health Relevance

Much of the care provided for people with Alzheimer's Disease (AD) comes from their husbands and wives who themselves can suffer more stress related diseases, including cardiovascular disease. To reduce health problems in caregivers, we wish to test a brief intervention called Behavioral Activation (BA), which helps people systematically to improve positive experiences in their lives and reduce their isolation. We expect that BA will be better than a more standard intervention based on providing information and support in improving both distress and multiple measures of vascular disease, thereby providing a new approach to bettering the lives and health of elderly caregivers.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Multi-Year Funded Research Project Grant (RF1)
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Biobehavioral Mechanisms of Emotion, Stress and Health Study Section (MESH)
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Nielsen, Lisbeth
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University of California San Diego
Schools of Medicine
La Jolla
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