Abstract
Background: Family dementia caregivers often suffer from an immense toll of grief while caring for their loved ones. We sought to identify the clinical relationship between grief, depression and mindfulness and identify neural predictors of symptomatology and improvement.Methods: Twenty three family dementia caregivers were assessed at baseline for grief, mindfulness and depression, of which 17 underwent functional magnetic resonance imaging (fMRI). During fMRI, caregivers were shown faces of either their dementia-stricken relative or that of a stranger, paired with grief-related or neutral words. In nine subjects, post fMRI scans were also obtained after 4 weeks of either guided imagery or relaxation. Robust regression was used to predict changes in symptoms with longitudinal brain activation (BA) changes as the dependent variable.Results: Grief and depression symptoms were correlated (r = 0.50, p = 0.01), and both were negatively correlated with mindfulness (r = −0.70, p = 0.0002; r = −0.52, p = 0.01). Relative to viewing strangers, caregivers showed pictures of their loved ones (picture factor) exhibited increased activation in the dorsal anterior cingulate gyrus and precuneus. Improvement in grief but not mindfulness or depression was predicted by increased relative BA in the precuneus and anterior cingulate (different subregions from baseline). Viewing grief-related vs. neutral words elicited activity in the medial prefrontal cortex and precuneus.Conclusions: Caregiver grief, depression and mindfulness are interrelated but have at least partially nonoverlapping neural mechanisms. Picture and word stimuli related to caregiver grief evoked brain activity in regions previously identified with bereavement grief. These activation foci might be useful as biomarkers of treatment response.
Highlights
Grief, broadly characterized as the psychological reaction to the perception of loss, is a normal emotional response unique to each individual and circumstance that can include characteristics such as shock and disbelief, sadness and low mood, frustration and anger, anxiety and fear and longing for the lost object (Bowlby, 1973; Rando et al, 2012)
Measures of predeath caregiver grief that account for these losses strongly correlate with caregiver burden (Liew et al, 2018), even when accounting for behavioral problems in the dementia patient and caregiver depression (Holley and Mast, 2009)
High levels of caregiver grief are associated with depression and caregiver strain (Chan et al, 2017), and with negative health outcomes post death of the care recipient (CR) (Givens et al, 2011; Shuter et al, 2014)
Summary
Broadly characterized as the psychological reaction to the perception of loss, is a normal emotional response unique to each individual and circumstance that can include characteristics such as shock and disbelief, sadness and low mood, frustration and anger, anxiety and fear and longing for the lost object (Bowlby, 1973; Rando et al, 2012). Predeath grief reactions can become prolonged and serially compounded as dementia progresses and losses accrue (Meuser and Marwit, 2001; Chan et al, 2013; Blandin and Pepin, 2017). Measures of predeath caregiver grief that account for these losses strongly correlate with caregiver burden (Liew et al, 2018), even when accounting for behavioral problems in the dementia patient and caregiver depression (Holley and Mast, 2009). High levels of caregiver grief are associated with depression and caregiver strain (Chan et al, 2017), and with negative health outcomes post death of the CR (Givens et al, 2011; Shuter et al, 2014). Dementia caregivers often suffer from an immense toll of grief while caring for their loved ones. We sought to identify the clinical relationship between grief, depression and mindfulness and identify neural predictors of symptomatology and improvement
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