Biopsychosocial influences on cognitive function in dementia spousal caregivers

Proposal Summary/Abstract
Caregiving for a spouse with Alzheimer’s disease and related dementias (ADRD) is a severe, chronic
stressor. The stress associated with ADRD spousal caregiving can be harmful to physical and cognitive health
and may partially explain why ADRD spousal caregivers are at heightened risk for accelerated aging and
chronic diseases of older adulthood, including ADRD1,2. Chronic stress can promote an overactive
proinflammatory state and impair mitochondrial function, processes which are both associated with cognitive
impairment3,4. However, not all ADRD spousal caregivers experience harmful effects of caregiving stress on
their health5. The ability to effectively regulate emotions may help explain individual differences in health
outcomes, as emotion regulation can impact physical and mental health. The process model of emotion
regulation proposed by James Gross states that a person may engage in regulatory strategies during the
experience of a stressor to change or modify the resulting emotion6–8. Two commonly-used strategies are
expressive suppression, which is an effortful inhibition of the outward expression of emotions, and cognitive
reappraisal, which involves reevaluating the meaning of an emotionally evocative situation6. The tendency to
use expressive suppression is associated with higher perceived stress, inflammatory dysregulation, and poor
health outcomes, while the tendency to use cognitive reappraisal is linked with lower perceived stress and may
protect against adverse effects of an overactive stress response9,10. As caregiving for a spouse with ADRD is
an extreme stressor, the use of expressive suppression may be harmful to the caregiver's health long term,
while cognitive reappraisal could protect against poor health outcomes. Although research has explored
emotion regulation in spousal caregivers, very few studies have examined biological and cognitive markers of
health in relation to emotion regulation in this population. This study aims to test the hypothesis that these
emotion regulation strategies are associated with cognitive function, inflammation, and mitochondrial function
in ADRD spousal caregivers. Specific Aims: (1) To examine the relationships between emotion regulation,
inflammation, mitochondrial function, and cognitive function. (2) To assess the relationship between
proinflammatory cytokines, mitochondrial function, and cognitive function. (3 - Exploratory) To explore
psychological, molecular, and cellular mechanisms of the association between emotion regulation tendencies
and cognitive function. This research could provide a better understanding about the role of emotion regulation
strategies in physiological and cognitive health in ADRD spousal caregivers. Results could broaden
knowledge about the mechanisms that underlie differences in health outcomes among ADRD spousal
caregivers and could yield important clinical implications for identifying individuals at risk and
tailoring interventions toward this vulnerable population.

Grant Number: 5F32AG090098-02
NIH Institute/Center: NIH
Principal Investigator: Kelly Brice