Objective:Although there is an increasing body of research that documents the role of hormones such as cortisol in stress, few investigators have studied hormonal status in caregivers of patients with Alzheimer’s disease. The objectives of this study were to (1) investigate the whether the stress of caring for patients with Alzheimer’s disease results in increased activity of hypothalamic-pituitary-adrenal (HPA) axis as demonstrated by increases in free cortisol and (2) to assess the effects of 27 group sessions of a psycho-educational support intervention augmented with a computer-telephone integrated system on caregiver cortisol levels.
Design: Open-label trial of behavioral intervention for caregivers of patients with Alzheimer’s disease.
Materials and Methods: Patient-caregiver dyads were recruited to participate in this study. Caregivers were provided with the opportunity to participate in a telephone-based support and information intervention over periods ranging from 8 to 12 months, for a total of 27 sessions. Free cortisol levels were quantified in saliva of caregivers at baseline, mid-intervention, and endpoints. Data were analyzed through simple zero-order correlations and t tests using SPSS and with a latent growth curve model created in the AMOS structural equation modeling software package.
Results:Cortisol levels were available at baseline for 37 participants, although data from all three assessment points were available for only 17 participants. Data analyses, including the growth curve model, were therefore carried out for the complete data set and for a subset that included only patients with data for all assessment points. Results for both set of analyses were similar. Analyses showed that cortisol levels were not associated with psychometric measures of depression and anxiety or with caregiver-reported hours of caregiving or caregiving burden at any time points. Cortisol levels, however, decreased significantly over the intervention period (p < 0.001). Growth curve analysis resulted in a significant slope of -0.753 (p < 0.001).
Conclusion:Results show that participation in a telephone-based support and information intervention may reduce caregivers’ cortisol levels. The relationship between stress-related hormones and negative outcomes, including depression and physical illness, has been consistently documented. These findings may have important implications for improving caregivers’ functioning and quality of life and reducing the morbidity associated with caregiving.
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