title: Dementia severity of the care receiver predicts procoagulant response in Alzheimer caregivers.
abstract: BACKGROUND
  The procoagulant factor D-dimer has been shown to be associated with thrombus formation and degradation as seen with conditions such as myocardial infarction and unstable angina. Research has demonstrated that spousal dementia caregivers have elevated levels of D-dimer relative to their non-caregiving peers.
  
  
  OBJECTIVE
  The objective of this study was to determine the relationship of basal level and laboratory stressor-induced concentration of D-dimer to severity of dementia in spousal care recipients.
  
  
  METHODS
  Seventy-one elderly caregivers were compared with a comparison group of 37 non-caregivers (average age: 71 years). Clinical Dementia Rating (CDR), a global measure of dementia, was used to assess severity of spousal dementia. Plasma D-dimer was measured at baseline and in response to an acute speech stressor.
  
  
  RESULTS
  Regression analysis revealed a significant positive association between severity of spousal dementia and caregiver D-dimer, both at baseline and in response to acute stress, while controlling for age. The model examined an exponential relationship, with D-dimer increasing progressively across the span of dementia stages.
  
  
  CONCLUSIONS
  Dementia severity of the care recipient was associated with increasing hypercoagulability among elderly caregivers. Effect size estimates suggest that such D-dimer increases may have clinical implications, particularly among late-stage caregivers.
authors.affiliation: Department of Psychiatry, School of Medicine, University of California-San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.
authors.forename: Kirstin
authors.initials: K
authors.lastname: Aschbacher
authors.forename: Roland
authors.initials: R
authors.lastname: von Känel
authors.forename: Joel E
authors.initials: JE
authors.lastname: Dimsdale
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Patterson
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Mills
authors.forename: Brent T
authors.initials: BT
authors.lastname: Mausbach
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Allison
authors.forename: Sonia
authors.initials: S
authors.lastname: Ancoli-Israel
authors.forename: Igor
authors.initials: I
authors.lastname: Grant
mesh_terms: D000368:Aged; D000544:Alzheimer Disease; D015415:Biomarkers / Q000378:metabolism; D017028:Caregivers / Q000523:psychology; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D012720:Severity of Illness Index; D018454:Spouses / Q000523:psychology; D013315:Stress, Psychological / Q000097:blood* / Q000209:etiology; D019851:Thrombophilia / Q000097:blood / Q000523:psychology
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D