Biological & Cognitive Markers of Dementia Caregiver Stress and the Impact of Caregiver Interventions

Transcription

1 Biological & Cognitive Markers of Dementia Caregiver Stress and the Impact of Caregiver Interventions Andrew P Allen Senior postdoctoral researcher, Dept. Psychiatry & Neurobehavioral Science & APC Microbiome Institute

2 Stressors

3 Stress reaction It s not stress that kills us, it is our reaction to it. Hans Selye

4 The Biology of Stress

5 Measuring Stress Hair

6 Informal dementia care

7 Aims 1. Highlight impact of carer stress to inform public policy 2. Assess cognition and biological markers of stress in informal dementia caregivers 3. Assess impact of interventions to manage carer stress

8 Caregiver assessment: Participants Caregivers (N = 74) Controls (N = 31) P-value Age 56.5 (SD = 11.9) 55.7 (SD = 10).75 Gender F = 49, M = 23 F = 21, M = Relation to care recipient Burden (ZBI; 22 item) Child = 47, Spouse = 25, Sibling = 1, Friend = (SD = 16.5)

9 Caregiver assessment: Methods CANTAB Flexible test battery assessing numerous cognitive domains Validated in wide variety of clinical populations Stress, depression & anxiety Cohen perceived stress scale Beck depression inventory Spielberger trait anxiety inventory

10 Caregiver assessment: Methods Stress biomarkers Blood: pro-inflammatory cytokines Salivary cortisol Stool Urine Hair

11 Higher Stress, Anxiety & Depression Stress (PSS; adjusted) Perceived Stress 20 * Control Caregiver Anxiety (STAI; adjusted) Anxiety 50 * Control Caregiver Depression (BDI; adjusted) Depression 15 * Controls Caregiver

12 Cognitive performance Memory Errors made (adjusted) Control * Caregiver Attention 600 Reaction time (ms; adjusted mean) Controls Caregiver

13 Cognitive performance CANTAB Other tests unaffected

14 Higher Pro-inflammatory Cytokine IL-6 IL Serum IL Serum IL Control Caregiver 25 TNF-a Control Caregiver 20 Serum TNF-a Control Caregiver

15 Positive Aspects of Caregiving

16 Positive Aspects of Caregiving Providing help to the care recipient has made me feel Question Agree a little (%) Agree a lot (%) more useful good about myself needed appreciated important 14 8 strong and confident 18 18

17 Positive Aspects of Caregiving Providing help to the care recipient has Question Agree a little (%) Agree a lot (%) enabled me to appreciate life more enabled me to develop a more positive attitude toward life strengthened my relationships with others

18 Carer Interventions Two group-based interventions Both offered to caregivers Approx. 2-month duration

19 Carer Training Program Carer training program

20 Mindfulness Mindfulness-based stress reduction

21 Carer Intervention Improves Performance Total errors Memory Baseline MBSR CPT 0 Baseline MBSR CPT

22 Carer Intervention Improves Performance Reaction time (ms) Attention speed Baseline MBSR CPT Total hits Attention accuracy Baselin MBSR CPT 0 Baseline MBSR CPT 0 Baseline MBSR CPT

23 Summary Caregiver assessment: Dementia caregiving impacts on cognitive performance Heightened stress, anxiety and depressive symptoms Heightened inflammatory cytokine Stress management: Improved cognitive performance

24 Brain-Gut-Microbiome Axis Grenham, Clarke et al., Frontiers in Physiology 2011

25 B. longum reduces stress in healthy human volunteers Stress 40 * Perceived stress Area under the curve Cortisol output * * Placebo Psychobiotic 0 Visit 1 Placebo Psychobiotic Brain activity * 4 * 8 Memory: total errors * Fz Mobility (Hz) PAL: Total errors Visit 1 Placebo Psychobiotic 0 Visit 1 Placebo Psychobiotic

26 Acknowledgements D William Molloy Aoife Ní Chorcoráin Judy Wall John F Cryan Timothy Dinan Eileen A. Curran Patricia M Kearney Gerard Clarke Caregivers who participated Nurses at Assessment & Treatment Centre, St Finbarr s Hospital Poonam Gururajan Glucksman

27

28 Research ongoing at UCC