Cognitive and physical consequences of caregiving individuals with Alzheimer's disease and related dementias: SBCares
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As the US population ages, older caregivers of persons with cognitive impairment (CPCI) are a rapidly growing demographic. While caregiver burden has been extensively studied in terms of stress, less attention has been directed toward caregivers’ cognitive health and maintenance of physical function. To address this critical gap, we propose a robust prospective cohort study, the Stony Brook Caregivers Research Study (SBCares), to examine the consequences, biology, and impact of caregiving among individuals supporting persons with Alzheimer’s disease and related dementias. The investigators propose a rigorous prospective study of 120 CPCI aged ≥60 years (and recipients) and 120 age- and sex-matched non-caregiver controls with the following aims. Aim 1. Assess cognitive fluctuations and associated factors in 120 older individuals caring for adults with Alzheimer’s disease or dementia and 120 non-caregiver controls. The team will use ecological momentary assessments (EMA), an innovative smartphone-based ‘cognitive measurement burst’ protocol. Unlike longer- term cognitive decline, short-term cognitive fluctuations captured by EMA reflect dynamic and potentially reversible processes. To identify variables that positively and negatively influence cognitive outcomes, the team will conduct a comprehensive assessment of caregiver and recipient-related characteristics, along with individual-level factors such as education, seasonality, and social connections. Aim 2. Establish the validity of novel digital biomarkers to predict longer-term cognitive decline in CPCI. Our recent studies demonstrate that multisensory integration and digital vocal biomarkers are associated with cognitive status and Alzheimer’s disease pathology. These tests can be done at home, reducing participation barriers for CPCI. Longer-term cognitive decline is assessed by the telephone Montreal Cognitive Examination, a valid and reliable remote screen of cognition, at baseline and every 6 months. Incident limitation in instrumental activities of daily living is the secondary outcome. MCI and dementia are examined as exploratory outcomes. Aim 3. Explore the interdependent status of frailty in caregiver–care recipient dyads. While some studies suggest spousal caregiving may accelerate frailty in caregivers, the reverse relationship is unclear: does frailty in older CPCI contribute to worsening frailty in dementia care recipients? To address this pragmatic issue, the team will longitudinally assess frailty every 6 months in 120 dyads of adults with Alzheimer’s disease and related dementias and their 120 CPCI recruited for Aims 1 and 2. By integrating longitudinal behavioral, cognitive, motor, and biological measures with novel digital biomarkers, SBCares will provide new insights into how caregiving affects the aging brain and body. These findings will not only clarify mechanisms linking caregiving to decline in cognition and function but also identify modifiable risk/protective factors and potential intervention targets. Ultimately, this work will inform strategies to sustain the health, resilience, and independence of in the growing US population of CPCI.
