• Caregiver stress (Revised Memory and Behavior Problems Checklist) [ Time Frame: 8 and 20 weeks ] [ Designated as safety issue: No ]
  

• CESD, Perceived Stress Scale, Caregiver self-efficacy, Neuropsychiatric INventory, AD-related quality of life, salivary cortisol, cytokines, telomere length, telomerase, heart rate, heart rate variability [ Time Frame: 8 and 20 weeks ] [ Designated as safety issue: Yes ]
  

Stress has a negative effect on many aspects of health. Older adults may be particularly sensitive to adverse effects of stress because of lower physiologic reserves and coexistence of other health problems. Since mind-body interventions may be most effective in conditions associated with psychological stress, this research will evaluate the effectiveness of a mind-body intervention in seniors who have a significant stress: being the primary caregiver for a person with dementia (PWD) secondary to Alzheimer's disease. The well-being of this large and growing group of Americans is a significant public health issue. We plan to study a Mindfulness Based Cognitive Therapy (MBCT) program for caregivers of a PWD in a randomized 3-arm intervention trial. There are two comparison groups: an education group and a pragmatic, respite only group. The two more active interventions, MBCT and education, also include identical respite care for the PWD to allow the caregiver to attend the classes. There will be 108 subjects aged 50-85 years including subjects from an African-American subgroup that have been followed by the Oregon Health & Science University (OHSU) Alzheimer's Disease Center. Each intervention will last 8 weeks, and consist of one 90-minute session per week along with at-home implementation of knowledge learned from the two more active interventions. Homework for the two groups will consist of home meditation practice for the MBCT group and development of an action plan and reading for the education group. Outcome measures will be assessed at 8 weeks and at 20 weeks (immediately and 12 weeks after the intervention class has been completed). Our primary outcome measure will be a self-rated measure of caregiver stress. There are a number of secondary outcome measures representing biomarkers of stress including: salivary cortisols measured over the day to include the awakening response and trough levels; inflammatory markers; and electrophysiologic markers measured with an innovative 24-hour physiologic data acquisition device (heart rate and heart rate variability, movement, respiration, and EEG). Other secondary outcome measures include self-efficacy, health-related quality of life, mood, and cognitive function. We will use several measures to predict response to MBCT and education in an aptitude by treatment interaction analysis. These measures include the personality trait absorption, emotion-based versus problem-based coping, and expectancy of improvement from each intervention. We will also use the 24-hour acquisition device to evaluate the ability of subjects randomized to MBCT to induce physiologic changes during self-reported mindfulness meditation and relate the magnitude of these changes to improvements in outcome measures.