title: Problem behavior of dementia patients predicts low-grade hypercoagulability in spousal caregivers.
abstract: BACKGROUND
  Low-grade hypercoagulability might be one pathway to explain how the chronic stress of dementia caregiving increases cardiovascular disease risk, but the specific aspects of caregiver stress that elicit hypercoagulability are elusive. We hypothesized that dementia patients' problem behaviors and negative reactions of caregivers to these behaviors would relate to hypercoagulability in caregivers.
  
  
  METHODS
  One hundred and eight participants (mean age 74 +/- 8 years, 70% women) providing in-home care for their spouse with Alzheimer's disease were examined. Caregivers were interviewed about the number of 24 predefined patient problem behaviors in the previous week (range 0-24) and how upset or bothered they felt in response to these behaviors (total score 0-96). Von Willebrand factor, plasminogen activator inhibitor-1, and D-dimer were determined in plasma and standardized z-scores of their concentrations summed into a procoagulant index.
  
  
  RESULTS
  Greater number of problem behaviors (Delta R(2) = 0.046, p = .014) and negative reactions of caregivers to these behaviors (Delta R(2) = 0.044, p = .017) were associated with greater procoagulant index after controlling for sociodemographic factors, major cardiovascular risk factors, health habits, and health problems. However, the number of and reaction to problem behaviors did not significantly predict procoagulant activity independent from each other. Post hoc analysis revealed a positive association between the number of problem behaviors and D-dimer (p = .010, Delta R(2) = 0.053), even when controlling for negative reactions (p = .033, Delta R(2) = 0.036). Caregiver reaction to problem behaviors was not significantly associated with any procoagulant factor individually.
  
  
  CONCLUSIONS
  Alzheimer patients' problem behavior and their negative appraisal by the caregiver may contribute to the chronic low-grade hypercoagulable state in dementia caregivers.
authors.affiliation: Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, CH-3010 Bern, Switzerland. roland.vonkaenel@insel.ch
authors.forename: Roland
authors.initials: R
authors.lastname: von Känel
authors.forename: Brent T
authors.initials: BT
authors.lastname: Mausbach
authors.forename: Joel E
authors.initials: JE
authors.lastname: Dimsdale
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Mills
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Patterson
authors.forename: Sonia
authors.initials: S
authors.lastname: Ancoli-Israel
authors.forename: Michael G
authors.initials: MG
authors.lastname: Ziegler
authors.forename: Susan K
authors.initials: SK
authors.lastname: Roepke
authors.forename: Matthew
authors.initials: M
authors.lastname: Allison
authors.forename: Igor
authors.initials: I
authors.lastname: Grant
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D017028:Caregivers / Q000523:psychology*; D003704:Dementia / Q000523:psychology*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D018454:Spouses; D013315:Stress, Psychological; D019851:Thrombophilia / Q000097:blood*; D014841:von Willebrand Factor / Q000032:analysis
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; D017395:Plasminogen Activator Inhibitor 1; C036309:fibrin fragment D; D014841:von Willebrand Factor