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Caregiving spouses at higher risk for dementia

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Researchers say the stress experienced by someone caring for a spouse with dementia might be responsible for heightened risk that the caregiver will also develop the condition. A few small studies had earlier suggested that spousal caregivers of dementia patients frequently have memory deficits greater than do spouses who aren’t caregivers, but none examined changes over time using standard criteria to diagnose dementia. (Credit: iStockphoto)

JOHNS HOPKINS (US)—Husbands and wives caring for spouses with dementia are six times more likely to develop the memory-impairing condition than those whose spouses don’t have it, according to results of a 12-year study.

The increased risk for caregivers is comparable to the power of a known gene variant to increase risk for Alzheimer’s disease, researchers report in the Journal of the American Geriatrics Society.

Dementia is a serious cognitive disorder; symptoms include problems with memory, attention, judgment, language and other abilities.

A few small studies had earlier suggested that spousal caregivers of dementia patients frequently have memory deficits greater than do spouses who aren’t caregivers. None of the previous research, however, examined changes in caregivers’ cognitive ability over time using standard, strict criteria to diagnose dementia.

Johns Hopkins University psychiatrist Peter Rabins and a team led by Maria Norton, an associate professor at Utah State University examined 1,221 married couples ages 65 or older. All were part of the Cache County Memory Study, which has identified more than 900 persons with dementia. The study participants live in Cache County, Utah, whose residents topped the longevity scale in the 1990 United States census.

Starting in 1995, the researchers began screening volunteers for dementia. The volunteers first completed questionnaires to evaluate their cognitive status. Those whose questionnaires suggested possible dementia underwent a comprehensive clinical assessment administered by specially trained nurses and technicians.

Finally, a team led by a geriatric psychiatrist and a neuropsychologist evaluated the findings and assigned a diagnosis of dementia where appropriate.

In the sample of 2,442 married persons, the researchers diagnosed 255 individuals with dementia and discovered that individuals whose spouses had already been diagnosed were six times as likely to develop the condition themselves compared with those without an affected spouse.

This increased risk is similar to the risk of developing Alzheimer’s disease associated with a well-studied gene variant known as APOE ε4, the researchers report. The findings held up even when the researchers accounted for other factors that might influence the risk of developing dementia, such as socioeconomic status.

Norton says the long-term nature of the new research makes the results different from earlier “snapshot” studies showing memory loss in spousal caregivers.

“We know that the declines in memory we saw were real and persistent, not just a point in time where they weren’t performing well on tests,” she says.

A strength of the Cache County Study, Rabins notes, is that the findings are highly representative of the community since the vast majority of residents age 65 or older are participating in ongoing research. Earlier studies have often relied on results from patients at memory centers and their caregivers, a sample that might not typify the community at large.

The researchers speculate that the stress of caregiving might be responsible for the increased dementia risk for spouses, although more research is need to identify what that mechanism might be. If their hunch is correct, Rabins says, doctors who treat dementia patients should pay more attention to efforts to decrease stress for spousal caregivers.

“Caregiving has positive aspects, as well as negative ones. If we can boost the positive aspects and reduce the negative ones, we may be able to reduce a caregiver’s risk of developing dementia,” Rabins says.

Researchers have long been interested in how taking care of a spouse with dementia affects caregivers. Most previous studies have focused on the emotional distress caretakers often experience, rather than how their cognitive abilities might be affected.

More news from Johns Hopkins: www.hopkinsmedicine.org/Press_releases/

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