DURHAM, N.C. -- Being the main caregiver for a spouse suffering from Alzheimer's disease can be a physically and emotionally draining experience -- the slow, unrelenting progression of the disease and its certain outcome put caregivers under constant pressure that can impact all aspects of their lives.
How these caregivers respond physically and emotionally to these demands can vary widely among individuals; some seem able to cope with the pressure while others suffer physically and/or mentally.
A group of Duke University Medical Center researchers believes that by carefully studying these caregivers they will be able to unravel the mysteries of why some people can successfully handle life's stresses in general and why others fare poorly. The researchers hope to be able to tease apart the interplay between genetics, neighborhood environment, psychological makeup and other factors with the ultimate goal of identifying those most at risk of succumbing to these stresses so the appropriate interventions can be developed.
Negative responses to stress can include such behavioral characteristics as anxiety and depression, as well as physical responses such as cardiovascular disease, hormonal and glucose imbalances, and high blood pressure. The novel Duke research project, which begins this month, is supported by a $2.6 million grant from three agencies of the National Institutes of Health: the National Institute of Environmental Health Sciences, the National Institute on Aging and the National Institute of Mental Health.
During the five-year project, the Duke researchers, led by Dr. Redford Williams, will conduct in-depth analyses of 200 caregivers of spouses with Alzheimer's disease or similar dementias. As a control, they will perform the same analyses on 200 people who are similar in all aspects to the caregivers, but who have a healthy spouse.
"By the end of this study we hope to better understand the underlying biological and behavioral mechanisms whereby stressful situations -- like caring for a spouse with Alzheimer's disease -- can contribute to health disparities between socioeconomic groups, as well as between racial groups," said Williams, who is director of Duke's Behavioral Medicine Research Center. "This is a truly innovative approach to a complex problem.
"The possible payoff is that we might be able to identify groups of people with certain characteristics -- whether psychological, genetic or environmental -- who are at a much higher risk of developing health problems under stressful situations and help them through early intervention," Williams said. "This is truly a study aimed at determining how the environment and genetics interact in contributing to the problems."
To better understand how the roles of environment and genetics can impact responses to stress, the researchers chose caregivers of Alzheimer's disease patients because there is a well-described body of scientific literature that shows that these caregivers do suffer from a broad range of physical and emotional problems.
"What makes Alzheimer's disease different from other diseases is that you gradually lose the person you love, and while they still have lucid moments, you have to make important decisions about that person without his or her understanding or input," said Lisa Gwyther, director of the Family Support Program (FSP) at the Duke Center for the Study of Aging and Human Development and co-investigator for the study.
"Many people have this romanticized vision that taking care of a sick family member comes easily and naturally," Gwyther continued. "But it doesn't come that easily for everyone, and it is not what people expect. Most of the stresses experienced by caregivers come from dealing with the unexpected, which is a hallmark of the disease."
In addition to documenting the stresses involved in the actual caregiving, the researchers also plan to conduct a detailed analysis of the environmental stressors present in each caregiver's neighborhood.
"We will be using a unique survey developed by our colleagues at the University of North Carolina at Chapel Hill, which not only takes into account census data for the neighborhood, but such factors as the overall quality of the housing, noise levels, safety issues and the social support network within the neighborhood," Williams explained.
With this knowledge, the team wants to see how certain moderators, such as genetics and certain personality traits, play into a caregiver's response to stress. One truly unique part of the study, according to Williams, will be elucidating the role of genetics. For each caregiver, the team will be looking for a particular naturally occurring form of a gene that controls the effects of a neurotransmitter called serotonin on the central nervous system. Previous studies have demonstrated that low levels of serotonin have been implicated in such negative behaviors or traits as hostility, depression, anxiety, alcohol abuse and smoking.
By the end of this project, we should able to pinpoint how this different form of the gene influences the responses to stress in different races as well as by gender," Williams said. "As results become clear during the study, we plan to share this information with the community to help improve the conditions of family members and caregivers who are under a tremendous amount of stress."
This community outreach will be overseen by the Duke FSP, which has a long history of providing assistance for families and professionals caring for patients with Alzheimer's disease and other similar disorders.
Materials provided by Duke University Medical Center. Note: Content may be edited for style and length.
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