Spouses who care for partners with dementia also at risk

May 16, 2010|By Kelly Brewington, The Baltimore Sun

For Marilyn Blum, the hardest part of dealing with her husband Steve's dementia was getting him to give up the car keys. There were the arguments, the denial and that day four years ago when he grabbed the keys, stormed off and started the ignition. He was lost for hours.

In the initial days of her husband's diagnosis of early onset Alzheimer's, her triglyceride level rose, her blood pressure jumped and stress took hold. "The early stage was horrible; it was very rough on both of us," said Marilyn Blum, 61, of Owings Mills.

The emotional toll of caring for a partner with dementia can be overwhelming — and wreak havoc on a caregiver's own health. New research from Johns Hopkins and Utah State suggests that stress may put a caregiver at risk for developing dementia as well. Spouses who cared for a partner with dementia had a sixfold increase in the risk of developing the disease, researchers found in a 12-year study.

"In addition to all the physical demands of taking care of an ill person, there are the psychological demands and stresses," said Johns Hopkins University psychiatry professor Dr. Peter Rabins, an authority on dementia and one of the study's authors. "This is a loved one, they sometimes don't know who you are, they accuse you of stealing things, that's stressful."

The intriguing findings need to be replicated with further study to better understand the possible link, researchers said. But experts have theories about how stress could be a factor. Alzheimer's can be latent for years, taking a decade for symptoms to show. Stress might speed up that development, Rabins said.

Other research suggests that high blood pressure, diabetes and high cholesterol can leave a person at risk for developing Alzheimer's disease, he said. Stress could cause caregivers to ignore their health, exacerbating these problems.

"It seems possible that people who are providing care, neglect their own physical wellbeing — they don't go to the doctor, they don't take their medication correctly," he said. "And then they are under a lot of stress, which worsens their blood pressure."

Researchers sought to identify risk factors for developing dementia with a group of 2,442 married couples 65 and older in Cache County, Utah. In addition to genetics and medical concerns, researchers looked at the role of stress, from early-life issues and late-life pressures to being a caregiver, as possible triggers for the disease.

At the end of the study, they found 225 people with dementia – 30 cases where both husbands and wives had developed the condition. While the majority of caregivers didn't end up with dementia, the increased risk for spouses surprised researchers.

Caregivers of all kinds can face enormous frustration, isolation and depression. But those who care for patients with Alzheimer's —a leading cause of dementia — face specific challenges associated with the puzzling disease, said Dr. Ronald C. Petersen, director of the Mayo Clinic's Alzheimer's Disease Research Center.

Physicians don't fully know what causes Alzheimer's, and there is no cure. While some genes have been found associated with the illness, doctors think environmental factors could also play a role.

As for dementia, experts aren't sure how stress might play a role in losing brain function. Stress might cause the secretion of chemicals in the brain, upsetting neural networks and altering brain function, Petersen said.

Patients with Alzheimer's don't get better, so caregivers can spend years putting forth tremendous effort with few rewards, he said.

"It's a relentlessly progressive disease," Peterson said. "And because of the nature of it, the patient can't appreciate all that is being done for him. So rarely do you see an Alzheimer's patient saying 'thank you.' "

For a married couple this can be especially trying.

"You're losing your intellectual mate, you can't talk about the same level of things," Peterson said. "You can't even talk about your family. A caregiver might say, 'Remember when the kids were growing up?' and the patient says, 'What kids'?

"Your whole life, everything that person meant to you and you meant to that person just withers away in front of you."

Add to that the heavy lifting of taking on new responsibilities in a household.

Marilyn Blum was forced to take responsibility for home repairs and family finances, areas that had been the sole domain of her husband, an accountant. And though the Blums had planned financially for the possibility of Steve coming down with the disease — his father was diagnosed with Alzheimer's at age 40 — the flood of new tasks overwhelmed Marilyn.

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