Abstract

Background

This study examined whether biological mechanisms linking dementia caregiving with an increased risk of coronary heart disease can be modified by psychosocial interventions and which caregivers might benefit the most from an intervention.

Methods

Spousal dementia caregivers were randomized to 12-week treatment with either a behavioral activation intervention (ie, Pleasant Events Program [PEP]; n = 60), or an active control Information and Support (IS; n = 63) condition. Indicators of caregiving stress were assessed pretreatment and circulating cardiovascular biomarkers were measured pre- and posttreatment.

Results

There were no significant changes in biomarker levels from pre- to posttreatment both by treatment condition and across all caregivers. Regardless of the treatment condition, exploratory regression analysis revealed that caregivers were more likely to show significant decreases in C-reactive protein (CRP) and D-dimer when their spouse had severe functional impairment; in interleukin (IL)-6 and CRP when they had greater distress due to care recipient’s problem behaviors; in tumor necrosis factor (TNF)-α when they had higher levels of negative affect; and in IL-6, CRP, TNF-α, and D-dimer when they had higher personal mastery. Within the PEP group, caregivers with higher negative affect and those with higher positive affect were more likely to show a reduction in von Willebrand factor and D-dimer, respectively. Within the IS group, caregivers whose spouse had severe functional impairment were more likely to show a decrease in IL-6.

Conclusions

Unlike the average caregiver, caregivers high in burden/distress and resources might benefit from psychosocial interventions to improve cardiovascular risk, although these observations need confirmation.

中文翻译：

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社会心理干预和护理压力对家庭痴呆症护理人员心血管生物标志物的影响：UCSD宜人活动计划（PEP）随机对照试验

摘要

背景

这项研究调查了通过社会心理干预能否改变将痴呆症护理与冠心病风险增加联系起来的生物学机制，以及哪些护理员可能会从干预中受益最大。

方法

配偶痴呆症的护理人员被随机分配至12周治疗，包括行为激活干预（即，愉快事件计划[PEP]；n = 60）或主动控制的信息和支持（IS; n = 63）条件。在治疗前评估护理压力指标，并在治疗前和后测量循环心血管生物标志物。

结果

从治疗前到治疗后，所有护理人员的生物标志物水平均无显着变化。不论治疗情况如何，探索性回归分析均显示，当配偶患有严重的功能障碍时，看护者更有可能表现出C反应蛋白（CRP）和D-二聚体显着下降。当白细胞介素（IL）-6和CRP因受护理者的问题行为而更加痛苦时；在肿瘤坏死因子（TNF）-α产生较高负面影响时；IL-6，CRP，TNF-α和D-二聚体具有较高的个人掌握能力。在PEP组中，具有较高负面影响的护理人员和具有较高正面影响的护理人员分别更有可能显示von Willebrand因子和D-dimer降低。在IS组中，

结论

与普通护理人员不同，负担重/困扰和资源高的护理人员可能会从心理社会干预中受益，以改善心血管疾病的风险，尽管这些观察结果需要证实。