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In-Home Respite Intervention Reduces Plasma Epinephrine in Stressed Alzheimer Caregivers

Received December 1, 2001; revised April 10, September 14, 2002; accepted September 16, 2002. From the University of California, San Diego and VA Healthcare System, La Jolla, CA. Address correspondence to Igor Grant, M.D., Department of Psychiatry (0680), University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0680.

OBJECTIVE: Some excess morbidity and mortality in Alzheimer caregivers (CGs) may be related to chronic activation of the sympatho-adrenal-medullary (SAM) system. Authors tested the efficacy of an in-home respite intervention to reduce peripheral markers of SAM activation and psychological distress in spousal caregivers of patients with Alzheimer disease. METHODS: Caregivers were classified as Vulnerable (n=27) or Non-Vulnerable (n=28). Vulnerable CGs were those with a severe mismatch between caregiving demand and help received in the preceding 6 months. CGs had plasma catecholamine levels sampled at rest and in response to a stressor (speech task) before and 1 month after a 2-week in-home respite intervention. Self-reported symptoms of anxiety and depression were also obtained. RESULTS: ANOVA revealed a group x treatment interaction: At the 1-month follow-up, plasma epinephrine declined significantly in the vulnerable caregivers who received respite, but rose in those who were wait-listed. No effect was found for norepinephrine, heart rate, blood pressure, or psychological symptoms. CONCLUSION: Findings suggest that an in-home respite program may reduce SAM activation independent of psychological symptoms. To the extent that sympathetic activation mediates pathophysiological events, these results suggest an approach that may reduce morbidity and mortality in certain caregivers.

Key Words: Alzheimer's Disease • Stress • Caregivers

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