Caregiver Closeness and Alzheimer's

According to a new study, Alzheimer’s patients who have close relationships with their caregivers may experience slower mental and physical decline. These beneficial effects were similar to common Alzheimer’s drugs, including galantamine (Razadyne®), donepezil (Aricept®) and rivastigmine (Exelon®).

In the Cache County Memory study, researchers have been studying more than 5,000 older adults since 1994 to identify potential risk factors for age-related dementia.

The authors evaluated a subset of 167 people who developed Alzheimer’s disease and were being cared for by either a spouse or adult child. Patient evaluations, which included physical, behavioral, functional, and cognitive health tests, were conducted every six months for four years. The participants and caregivers were also asked about their relationships with the patients.

The researchers found that physical and mental decline was slowest among those who had the closest patient-caregiver relationships. In general, these beneficial effects were most apparent among patients who were cared for by their spouses.

It is unclear exactly why close relationships were linked to delayed disease progression. Growing evidence suggests that maintaining mental fitness and participating in social activities may help delay the onset of dementia. Some researchers suspect that lifelong mental exercise and learning may promote the growth of additional synapses, the connections between neurons, and delay mental decline. Other researchers argue that advanced education gives a person more experience with the types of memory and thinking tests used to measure dementia. Doing crossword puzzles, reading books and increasing social activities are recommended by healthcare providers.

For more information about Alzheimer's disease please visit Natural Standard's Medical Conditions database.

Comments

[P. Beasley]

It would be interesting to look at the correlation between close relationships and the common Alzheimer's medications. It could be beneficial to prove whether close relationships with caregivers enhances the effect of medications. Also, it may be helpful to look at the social pasts of these patients to see if activities, like crossword puzzles and reading, could be suggested as effective preventive, or at least disease-delaying, therapy.

[Smith]

This study makes an interesting point. Could it be that the closer the Alzheimer's patient is with their caregiver, the more interactions they will have? Could these interactions stimulate more cognitive function, which in turn, retains some of their brain function or memory? I read in a study somewhere that marriage has been linked to lower incident of Alzheimer's disease.

[Danielle]

I just read an amazing book on Alzheimer’s that everyone should check out- it’s called "Still Alice" by Lisa Genova. It’s from the patient’s point of view, and it really helps the reader understand the disease a little better.

[fran]

This is an interesting study because it shows scientifically why a patient with Alzheimer’s shouldn’t be put in a facility if it can be prevented. Although I haven't had to care for a family member with Alzheimer’s myself, I would assume that it is an extremely difficult endeavor, and that one would feel like their efforts are in vain. It’s nice to know that I can help give caregivers (particularly spouses) hope by saying that are actually scientifically helping their loved one just by being the one to care for them, and their efforts are not for nothing!

[Michelle D]

It is interesting to read about non-pharmaceutical ways to slow down Alzheimer’s disease. This is one of the most devastating conditions for both the patients and their caregivers. It is very difficult for relatives and close ones to witness the mental degeneration of their love ones. The link between close relationships with caregivers and the slowing down of mental and physical decline should be further evaluated in more prospective, observational studies.

What does the author mean when suggesting that the beneficial effects are comparable to Alzheimer’s drugs? Does this mean that it could replace conventional treatments? I’ve learned that these drugs have various adverse effects on patients (particularly since these patients are elderly). It would be great if we could limit the use of the drugs and still benefit the patients.

[B]

It would be beneficial to find out if any of these patients were taking medications indicated for Alzheimer’s disease. The drugs available for Alzheimer’s disease delay the progression of the disease by six months to a year. Donepezil was proven to delay progression by one year while the others were less than a year. Therefore, if these patients were taking any medications for Alzheimer’s disease, such as galantamine, donepezil or rivastigmine, that would greatly affect the time to mental and physical decline. I would like to find out if it was solely the close relationship with the caregiver that played a role in this improvement.

[Allie Openheimer]

It is a comforting thought to believe that caregiver closeness can help slow the decline of Alzheimer’s disease in a friend or relative. This study is a good start, but further randomized control studies must be done before any real conclusions can be made. This study does not seem like it was blinded, and therefore, researcher bias can definitely come into play, especially with such an emotional subject. It is also subjective to say that caregiver closeness produced results similar to donepezil and other common Alzheimer’s drugs. What scale was used to assess this? I want to see statistical values to prove that.

[Micah]

Similar to Smith’s comments above, I'm wondering if the close relationship does something to stimulate a patient's cognition and memory. If they have a stronger recognition and more ties and previous mental connections to a person, it seems to make sense that they could stay stronger mentally. I'm not sure how the physical part of the equation is affected though, that seems more puzzling.

I'm curious about the subset size in the study. Since the larger study consisted of 5,000 older adults, were only 167 being cared for by spouses? It seems like a low number, but then again, it is incredibly challenging and difficult to care for an Alzheimer's patient, so this is not to dismiss that at all.

[Nicole]

This study is very encouraging for patients with Alzheimer’s disease (AD)! I know that acetylcholinesterase inhibitors (AChEIs), the most effective drugs for AD, have a very limited window of activity in patients with AD; meaning that after around 5 years, their effectiveness in slowing AD drops dramatically. The fact that close family members acting as caregivers for patients with AD has proved to slow the progression as effectively as AChEIs is great for long-term AD therapy. Patients with AD who are fortunate enough to have a close family member care for them can now delay the initiation of AChEIs without their AD progressing which gives them many more functional years.

[tina]

The study measured caregiver closeness based on what the caregivers stated. I’m not sure if this is a concrete, unbiased enough form of measurement for me. I would be interested to see this study redone with different forms of outcome measures, etc.

[Jonelle]

As we age, all our body functions tend to decline and that also includes the memory. According to Natural Standard monograph, Alzheimer's disease (AD) causes loss of memory, reasoning, judgment, movement coordination and pattern recognition as the functionality of brain cells deteriorate. Doctors often recommend that retired people find things to be occupied with to avoid memory decline. Usually, family closeness and mental activities are keys to delay this progressive disease. The patients are recommended to do activities with family members like puzzles and always try to be engaged in some activities to feel sense of independence and delay Alzheimer’s.

[ava]

Similar to the comments posted above, I'm not convinced that this study was powered by enough patients to show that closeness of caregivers plays a significant role in Alzheimer's disease progression. The data are optimistic; however, and practitioners should make caregivers of Alzheimer’s patients aware of the research behind the possible benefits of their close relationships on disease progression.

I’m interested in learning more about the scale that was used to measure “caregiver closeness” since this seems to be a very subjective way of collecting data. I imagine that relationships can be interpreted in different ways, depending on the evaluator's personal point of view of “closeness.”

[stooch3]

The gradual decline of memory witnessed in Alzheimer’s disease patients can be categorized as either short-term or long-term memory loss. It would be interesting to note which kind of mental decline was seen to be the most delayed by caregiver closeness.

I would imagine that caregiver closeness would show a greater impact in preventing long-term memory loss than it does in preventing short-term memory loss simply because close caregivers are knowledgeable of the AD patient’s background and can help facilitate story telling or recounting a memory -- something that an outside caregiver would never be able to do.

In terms of delaying short-term memory loss, AD patients may feel less embarrassed and more encouraged by a close caregiver than an outsider, but this is something that an outsider can overcome with patience and sympathy.

[Steven]

Age-related dementia is a concern to many, especially to family members since they too share in the suffering of their loved ones who are losing their mental abilities. Could it be that the symptoms of Alzheimer's are less severe in patients with close caregivers because they have more of a reason to thrive and so have a greater drive to improve their health? Also, maybe having a loved one around them so much will help trigger memories of the past and therefore, aid in neural functioning. It's also sad to think about elderly people placed in long-term care facilities by family members because it seems that they will have less of a chance to nurture the kind of close relationships that might be beneficial for their health.

[Cheryl]

No one will argue that memory-strengthening activities, like socializing, reading, and crossword puzzles, are harmful, so no one is not going to recommend them. What we need to figure out now is when to start them. Should we start reading to our kids while they are in the womb or should we do the jumble every Sunday with our parents when they hit 45?

[Milley]

I agree with Tina. What does a “close relationship” even mean? Does it include loving, nurturing, and interacting with the family member all day, every day? Or does a close relationship mean just turning on their TV shows to watch and letting them sit in a room all day? I do think that this is a little ray of light in an area that has not seen any real breakthroughs in a while, but we need much more information on what the actual definition closeness is so we can help our loved ones.

[marc]

Maybe slower decline just has to do with engaging in an activity or conversation you’re interested in. It might be better to talk about recipes with your grandmother or sports with a retired athlete than to just encourage them to do a crossword puzzle by themselves. A previous blogger commented on doing the Sunday jumble with family members. Could it be that the problem-solving of the jumble isn’t the only thing helping them? Maybe it’s also the stimulation of interacting with other human beings? It’s common to hear Alzheimer’s patients talk and act as if they are in a different time or place. They might remember those far-away times so vividly because it brought them joy. Slower decline may come from creating more joyful moments for them to remember now as they age.

[Nancy]

According to the National Institute on Aging (NIA), Alzheimer's disease is the most common form of dementia. Dementia is a group of disorders that impairs mental functioning. Dementia means loss of the ability to think. Alzheimer's is progressive and irreversible. Abnormal changes in the brain worsen over time, eventually interfering with many aspects of brain function. Memory loss is one of the earliest symptoms, along with a gradual decline of other intellectual and thinking abilities, called cognitive functions, and changes in personality or behavior.

Age is the most important risk factor for AD. The number of people with the disease doubles every five years beyond age 65.

Because early symptoms of Alzheimer's disease (AD) progress slowly, diagnosis is difficult and often delayed. The disease's course varies from person to person. Eight years is the average length of time from diagnosis of Alzheimer's to death. Survival begins to decline three years after diagnosis, but some people live more than a decade with the disease. It has been found that patients who have more family or caregiver closeness usually tend to do better and disease progression is slowed. Future evidence-based study will be needed in order better understand facts about caregivers and Alzheimer’s disease.

[YJL]

I find this study very encouraging, and it shows we really need to give credit to the caregivers. Caring for a family member who has Alzheimer's disease is very challenging and stressful. It is a 24/7 job, and I truly believe that their efforts do have an impact on the disease progression. I do hope more scientific evidence is needed to provide proof that the caregiver's efforts are significant in slowing the disease progression and improving the patient's quality of life.

[bob]

I think close relationship with caregivers can benefit not only patients with Alzheimer’s disease, but also patients with other disease conditions as well. This close relationship can especially help prevent depression in a lot of elderly patients in nursing homes or long-term care facilities. I feel that patients in physical rehabilitation centers can also be more motivated from close relationships to physical therapist and nurses. But, I am surprised to read that close relationships had almost the same effect as some of the drugs in Alzheimer’s patients.

[Sean]

Alzheimer's disease (AD) is a progressive disease, and it advances in stages, from mild forgetfulness and cognitive impairment to widespread loss of mental abilities.

The time course of the disease varies by individual, ranging from five to 20 years. The same factors that put an individual at risk of heart disease, including high blood pressure and high cholesterol, may also increase the likelihood that the person will develop AD. Poorly controlled diabetes is another risk factor. Exercise and diet are very important to prevent and control AD. Some clinical studies have suggested that remaining mentally active throughout life, especially in the later years, reduces the risk of AD. Mental activities like doing crossword puzzles daily, reading the newspaper or books and increasing social activities is thought to minimize the progress.

According to the Natural Standard monograph, in advanced Alzheimer's, people become dependent on others for every aspect of their care. The bottom line is, the relationship between the caregiver and Alzheimer’s patient does play a very important role, but more clinical studies are needed before firm conclusions can be drawn.

[Sam]

According to the National Institute on Aging (NIA), Alzheimer's disease is the most common form of dementia. Dementia is a group of disorders that impairs mental functioning. Dementia means loss of the ability to think.

Alzheimer's is progressive and irreversible. Abnormal changes in the brain worsen over time, eventually interfering with many aspects of brain function. Memory loss is one of the earliest symptoms, along with a gradual decline of other intellectual and thinking abilities, called cognitive functions, and changes in personality or behavior.

Age is the most important risk factor for Alzheimer's. The number of people with the disease doubles every five years beyond age 65. There is no known cure for the disease, although researchers have made progress on determining its causes.

Because early symptoms of progress slowly, diagnosis is difficult and often delayed. The disease's course varies from person to person. Family does play an important part in coping with Alzheimer patients. The closer the caregivers are to AD patients, the slower the progression of AD, it is generally seen. More research is needed before a more firm conclusion can be drawn.

[Steve]

I saw something on TV not too long ago where they used pet therapy to treat Alzheimer’s in elderly patients. I’m wondering if caregiver closeness is using some of the same principles as the pet therapy?

From what I understand, the pets provide the patients with a form of comfort. Although the patients may forget names, or particular individuals, they seemed to react well with a friendly dog coming in to keep them company for a period of time. Also, with Alzheimer’s, if the patient is forgetting major aspects of their surroundings, it could get lonely quite quickly. So the idea of having the caregiver as an active participant, and being close to the patient, could lead to slower decline in behavioral and mental states.

[Liz]

I agree with earlier posts that caregivers play an extremely important role in an Alzheimer's patient's progression. When evaluating AD patients, healthcare providers must also evaluate their caregivers for signs of depression, anxiety or other conditions that warrant significant attention. Caregivers must be reminded that they are doing an extraordinary thing and should not be hard on themselves for having these feelings that they might classify as "weaknesses."

Practitioners must take a comprehensive look at the patient and his/her environment and recognize that treatments extend beyond the typical prescription medications. Natural Standard can serve as an excellent source for such treatments.

[end]

This is a really interesting post for me because after taking a couple of sociology classes — more specifically sociology of the aging — I became a little obsessed with this topic. I’ve read several books written by caretakers of people with dementia. The general theme of these books has always been that it’s a battle of the will to keep such close contact while the people you love are deteriorating. While it’s a very hard thing to see a loved one go through, it may make some people more at ease knowing that it help slow physical and mental decline. I also like the last sentence about doing crossword puzzles, etc.; I would recommend Sudoku for anyone!