title: Effect of Alzheimer caregiving on circulating levels of C-reactive protein and other biomarkers relevant to cardiovascular disease risk: a longitudinal study.
abstract: BACKGROUND
  Providing care to a spouse with Alzheimer's disease (AD) may contribute to cardiovascular disease (CVD). The acute phase reactant C-reactive protein (CRP) is a well-established biomarker of an increased CVD risk.
  
  
  OBJECTIVE
  To investigate the hypothesis that dementia caregiving is associated with elevated circulating levels of CRP and possibly other biomarkers of CVD risk.
  
  
  METHODS
  We examined 118 elderly spousal Alzheimer caregivers and 51 noncaregiving controls about once a year for up to 3 years. Random regression models with fixed and time-variant effects for a range of covariates known to affect biomarker levels were used to evaluate changes in CRP and in 12 additional measures of inflammation, cellular adhesion, endothelial function, and hemostasis in relation to caregiving status, years of caregiving, and major transitions in the caregiving situation.
  
  
  RESULTS
  During the study period, longer duration of caregiving was associated with elevated CRP levels (p = 0.040) and caregivers showed greater tumor necrosis factor (TNF)-α levels than controls (p = 0.048). Additionally, 3 months after the death of the AD spouse, caregivers showed a significant drop in CRP levels (p = 0.003) and levels of soluble intercellular adhesion molecule (sICAM)-1 (p = 0.008).
  
  
  CONCLUSIONS
  Duration of caregiving and being a caregiver per se were both associated with chronic low-grade inflammation as indicated by elevated CRP and TNF-α levels, respectively. Conversely, death of the AD spouse was associated with lower CRP and sICAM-1 levels. The findings indicate that chronic caregiving of those with dementia may result in increased inflammation and, thereby, possibly increased CVD risk.
authors: Division of Psychosomatic Medicine, Department of General Internal Medicine, Inselspital, Bern University Hospital and University of Bern, Switzerland. roland.vonkaenel@insel.ch
authors: Roland
authors: R
authors: von Känel
authors: Paul J
authors: PJ
authors: Mills
authors: Brent T
authors: BT
authors: Mausbach
authors: Joel E
authors: JE
authors: Dimsdale
authors: Thomas L
authors: TL
authors: Patterson
authors: Michael G
authors: MG
authors: Ziegler
authors: Sonia
authors: S
authors: Ancoli-Israel
authors: Matthew
authors: M
authors: Allison
authors: Elizabeth A
authors: EA
authors: Chattillion
authors: Igor
authors: I
authors: Grant
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000628:therapy*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000097:blood* / Q000209:etiology* / Q000523:psychology; D017028:Caregivers / Q000523:psychology*; D016022:Case-Control Studies; D016207:Cytokines / Q000097:blood; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013315:Stress, Psychological
chemical_list: D015415:Biomarkers; D016207:Cytokines; D002097:C-Reactive Protein