Effects of gender and dementia severity on Alzheimer’s disease caregivers’ sleep and biomarkers of coagulation and inflammation

Abstract

Background Being a caregiver for a spouse with Alzheimer's disease is associated with increased risk for cardiovascular illness, particularly for males. This study examined the effects of caregiver gender and severity of the spouse’s dementia on sleep, coagulation, and inflammation in the caregiver. Methods Eighty-one male and female spousal caregivers and 41 non-caregivers participated (mean age of all participants 70.2 years). Full-night polysomnography was recorded in each participants home. Severity of the Alzheimer's disease patient’s dementia was determined by the Clinical Dementia Rating (CDR) scale. The Role Overload scale was completed as an assessment of caregiving stress. Blood was drawn to assess circulating levels of D-dimer and Interleukin-6 (IL-6). Results Male caregivers who were caring for a spouse with moderate to severe dementia spent significantly more time awake after sleep onset than female caregivers caring for spouses with moderate to severe dementia (p = 0.011), who spent a similar amount of time awake after sleep onset to caregivers of low dementia spouses and to non-caregivers. Similarly, male caregivers caring for spouses with worse dementia had significantly higher circulating levels of D-dimer (p = .034) than females caring for spouses with worse dementia. In multiple regression analysis (adjusted R2 = .270, p<0.001), elevated D-dimer levels were predicted by a combination of the CDR rating of the patient (p = .047) as well as greater time awake after sleep onset (p = .046). Discussion The findings suggest that males caring for spouses with more severe dementia experience more disturbed sleep and have greater coagulation, the latter being associated with the disturbed sleep. These findings may provide insight into why male caregivers of spouses with Alzheimer's disease are at increased risk for illness, particularly cardiovascular disease.

Gender differences in insomnia and the role of paid work and family responsibilities

“…Further research is needed to examine the effect of household tasks on insomnia. Several studies have previously shown high risks for adverse mental and physical health, including sleep disturbance, among non-paid caregivers [52][53][54][55][56]. In our research, although the proportion of participants who lived with persons who needed care and support was small (male, 2.8%; female, 5.7%), having to provide nursing care was significantly associated with insomnia.…”

Stress and Aging: A Biological Double Jeopardy?

“…A growing body of evidence also indicates greater proinfl ammatory activity in caregivers as compared with controls, including higher levels of CRP, IL-6, and D-dimer, a coagulation marker (Kiecolt-Glaser et al, 2003;Miller et al, 2008;Mills et al, 2009;Rohleder et al, 2009;von Kanel et al, 2006), although the specifi c patterns of proinfl ammatory biomarkers that differ between caregivers and controls vary somewhat across studies. Similar immune correlates of chronic stress are found in meta-analytic studies examining a wide array of chronic stressors across individuals of different ages (Herbert & Cohen, 1993;Segerstrom & Miller, 2004).…”

Short-term changes in sleep, mastery & stress: Impacts on depression and health in dementia caregivers

“…The poor sleep can be perpetuated by changes in sleep hygiene, with behaviors such as increased caffeine intake or irregular bed hours to make up for poor sleep leading in turn to sleep deficiency. 23 Sleep deficiency resulting from poor sleep has been associated with indicators of decreased well-being such as obesity and diabetes, 24 increased cardiovascular risk, 25,26 and increased mortality, 27 as well as increased levels of stress and depression. 22,28 Sleep has been reported to vary in the individual on a night-to-night basis.…”