Stress biomarkers as outcomes for support groups for people with memory loss and their caregivers (SO CALM)

Abstract

AbstractBackgroundDespite the significant burden neuropsychiatric symptoms impose, rigorous research on behavioral interventions to address anxiety, apathy, and depression in people with dementia is limited, especially in those with mid‐ to late‐stage dementia. The Memory Counseling Program (MCP) at Wake Forest School of Medicine offers multi‐tiered support groups that are unique because 1) they are 10‐week, structured groups rather than open, monthly support groups and 2) they include the person living with dementia (PLWD) rather than targeting the caregiver alone.MethodWe measured quantitative biomarkers of stress to complement self‐reports at baseline, prior to initiation of support groups, with follow‐up visit within 10 days of last support group. We used paired t‐tests to examine the differences between pre‐group and post‐group measures for caregivers (Perceived Stress Scale, urinary cortisol, and allostatic load) and for PLWD (Apathy Evaluation Scale, urinary cortisol, and allostatic load). Allostatic load is the burden of chronic and repeated exposure to stress and a marker of stress resilience derived from a combination of labs, blood pressure, waist‐to‐hip ratio, and body‐mass index.ResultAmong 20 participants (1:1 caregiver and PLWD), self‐reports of Perceived Stress Scale and Apathy Evaluation Scales did not change after support group participation, however biomarkers of urinary cortisol and allostatic load decreased significantly after group participation. Among 10 caregivers, urinary cortisol changed from baseline mean 15.6µg/L (SD 12.7) to follow‐up mean 10.3 µg/L (SD 11.4, p<0.05) and allostatic load from baseline mean 5.6 (SD 2.1) to follow‐up mean 4.4 (SD 1.4, p<0.06). Among 10 PLWD, their mean baseline urinary cortisol 22 µg/L (SD 18.3) decreased to 9.8 µg/L (SD 8.0) at follow up and their allostatic load decreased from 5.9 (SD 2.1) at baseline to 5.1 (SD 1.5, p<0.05) at follow up.ConclusionThe Wake Forest Memory Counseling program non‐pharmacologic 10‐week structured support groups may be able to reduce objective stress biomarkers for both caregivers and PLWD. Future studies should test structured support groups with an active attention control in a prospective manner.