Effects of placement and bereavement on psychological well-being and cardiovascular risk in Alzheimer's caregivers: a longitudinal analysis.
OBJECTIVE
We examined the impact of Alzheimer caregiver transitions (i.e., placement and bereavement) on psychological outcomes and on plasma D-dimer levels, an end product of the coagulation cascade associated with increased cardiovascular risk.


METHODS
This was a prospective study in which 126 spousal caregivers of Alzheimer's patients were assessed each year for 5 years. We used random regression models to evaluate discontinuous change in our outcomes over time, with emphasis on the impact of caregiver transitions on psychological and physical well-being.


RESULTS
Caregivers experienced immediate improvement in overload and mastery following transitions, and these improvements were maintained over time. There was also a significant drop in depressive symptoms immediately following placement of spouses. D-dimer rose significantly over time but began to significantly decline at 6-months posttransitions.


CONCLUSIONS
Caregiver transitions appear to produce immediate and long-term "normalization" of psychological health in caregivers. This normalization also appears related to "downstream" reductions in D-dimer.
Mausbach
Brent T
BT
Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093-0680, USA. bmausbach@ucsd.edu
Aschbacher
Kirstin
K
Patterson
Thomas L
TL
von Känel
Roland
R
Dimsdale
Joel E
JE
Mills
Paul J
PJ
Ancoli-Israel
Sonia
S
Grant
Igor
I
D000223:Adaptation, Psychological / Q000502:physiology; D000368:Aged; D000544:Alzheimer Disease / Q000523:psychology* / Q000628:therapy; D001601:Bereavement; D002318:Cardiovascular Diseases / Q000097:blood / Q000175:diagnosis / Q000523:psychology*; D017028:Caregivers / Q000523:psychology*; D017281:Cost of Illness; D003863:Depression / Q000097:blood / Q000175:diagnosis / Q000523:psychology; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006801:Humans; D007389:Internal-External Control; D008134:Long-Term Care / Q000523:psychology; D008137:Longitudinal Studies; D008297:Male; D010343:Patient Admission; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D012307:Risk Factors
D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D