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Dementia Severity of the Care Receiver Predicts Procoagulant Response in Alzheimer Caregivers

From the Department of Psychiatry, University of California, San Diego, California (KA, RvK, JED, TLP, PJM, BTM, SA-I, IG); the Department of General Internal Medicine, University Hospital Bern, Bern, Switzerland (RvK); San Diego Veterans Affairs Healthcare System, La Jolla, California (TLP, SA-I, IG); and Family and Preventive Medicine, University of California, San Diego, California (MAA).

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 noncaregiving 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 noncaregivers (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.

Discussion: 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.

Key Words: Hemostasis • coagulation • cardiovascular • geriatric • progressive dementia • Alzheimer disease

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