Mental health in familial caregivers of Alzheimer’s disease patients: are the effects of chronic stress on cognition inevitable?

Abstract

Familial caregivers of Alzheimer's disease (AD) patients experience an emotional and physical burden which characterizes a chronic stress condition. The resulting hypothalamic-pituitary-adrenal axis dysfunction favors an imbalance of neurotoxic/neuroprotective factors and causes cognitive impairments, increasing the caregivers' risk for cognitive decline and compromising their ability to provide adequate care of the patient. Therefore, the present study aimed to investigate the reversibility of the cognitive impairments of familial caregivers of AD patients during their caregiving-related chronic stress condition. Thirtythree caregivers (61.42 þ 2.68 years; 27 women) and thirty-four controls (57.91 ± 2.16 years, 20 women) were evaluated for their cognitive functioning (attention, executive function, processing speed and memory) with a neuropsychological battery (Digit-span, Trail Making, Stroop and the Logical Memory tests). Subjects' cortisol/dehydroepiandrosterone (DHEA) ratios were determined by radioimmunoassay, and their brain-derived neurotrophic factor (BDNF) levels were analyzed by ELISA. An incidental contextual memory task, with or without an associative encoding instruction, was used to investigate if caregivers have a cognitive reserve prone to rehabilitation. The contextual memory impairment of caregivers was associated with prefrontal and hippocampal cognitive dysfunctions, alterations of the cortisol/DHEA ratio and lower BDNF levels. Even so, the contextual memory impairment could be improved by the associative encoding condition. This study suggests that the cognitive impairments of caregivers are not necessarily irreversible, as indicated by the results obtained for contextual memory, which could be improved despite the ongoing chronic stress and associated hormonal and neurotrophin dysfunctions. Lay summary The support of a relative with Alzheimer's Disease submits the familial caregivers to a chronic stress condition that increases their own risk of cognitive decline. This study suggests that, irrespective to their alterations on cortisol/DHEA ratio and BDNF levels, caregivers have a cognitive reserve that could probably be engaged to limit the negative effects of chronic stress on cognition.

The Mediational Role of Burden and Perceived Stress in Subjective Memory Complaints in Informal Cancer Caregivers

“…Prior research has suggested that during earlier stages of cognitive decline, subtle memory complaints may not have a functional impact, although it has been reported that poor results obtained in MFE-30 may be an indicator of future development of dementia [37,47]. Many studies directed to analyze the impact of caregiving on cognition have focused on the effects of taking care of people with dementia suggesting that caregivers display greater vulnerability to cognitive decline [32,48].…”

The Mental Health of Caregivers and Their Patients With Dementia During the COVID-19 Pandemic: A Systematic Review

“…Considering that this pandemic could be long-lasting and that the mental health of caregivers of patients with cognitive decline/dementia has been demonstrated to be at risk regardless of the COVID-19 emergency (De Fazio et al, 2015;Corrêa et al, 2019;Lloyd et al, 2019), there is a need to investigate the real effects of the current emergency on caregivers of patients with dementia to identify and address adequate interventions (Liu et al, 2021).…”

Family Caregivers of People with Dementia Have Poor Sleep Quality: A Nationwide Population-Based Study

“…The detrimental influences of informal caregiving on the physical, psychological, and social wellbeing of dementia caregivers are well documented in previous investigations. Specifically, family caregivers of PWD were found to have higher risks of atherosclerosis [ 34 , 35 , 36 , 37 ], poorer physical health conditions [ 4 , 10 , 38 ], cognitive impairments [ 6 , 7 , 8 , 9 ], and poorer psychological health including stress [ 39 ], depression, and anxiety [ 13 , 40 , 41 , 42 ]. Consistent with the aforementioned studies, our study showed that caregivers of PWD had higher prevalence of hypertension, diabetes mellitus, subjective cognitive decline, and depression than noncaregivers.…”

“…Family caregivers of PWD are more likely than family caregivers of people without dementia to help with emotional or mental health problems (41% versus 16%) and behavioral issues (15% versus 4%) [2]. Previous studies also documented psychological stress, depressive symptoms, and cognitive impairments in verbal memory, attention, and executive function in family caregivers of PWD [5][6][7][8][9][10][11][12], which may be attributed to their sleep disturbances [13][14][15][16][17][18][19][20].…”