Psychobiological Monitoring of a Home-Based Dyadic Intervention for People Living with Dementia and Their Caregivers: Added Value to Evaluate Treatment Success and Understand Underlying Mechanisms

Abstract

Background: Research concerning people living with dementia (PwD) and their informal caregivers (ICs) has recently begun to focus on dyadic aspects of psychosocial interventions. Objective: We adapted a dyadic psychosocial intervention and examined its effects on psychobiological stress in daily life. Methods: Twenty-four PwD-caregiver dyads were visited seven times at home by specialized nursing staff. Momentary subjective stress, salivary cortisol (sCort), and salivary alpha-amylase (sAA) were measured in PwD and ICs before and after each home visit as well as six times per day at two days each at the beginning and end of the intervention as part of an ambulatory assessment. Hair cortisol concentrations (HCC) were measured twice. Results: After each home visit session, ICs reported lower subjective stress. sCort was lower in both ICs and PwD, whereas sAA did not change. In daily life, area under the curve (AUCg) concerning sCort secretion indicated that PwD had lower sCort daily output at the end of the intervention, and AUCg concerning subjective stress indicated that both PwD and ICs reported lower subjective stress than at the beginning of the intervention. AUCg concerning sAA did not change over time in either group. HCC did not vary over time but increased with disease severity. Conclusion: The psychosocial intervention reduced psychobiological stress but affected psychobiological stress measures differently in PwD and ICs. In particular, the discrepancy between subjective and physiological markers of stress in PwD emphasizes the added value to evaluate treatment success and understand underlying mechanisms as a complement to self-reports.

Psychobiological Evaluation of Day Clinic Treatment for People Living With Dementia – Feasibility and Pilot Analyses

“…The assessment of physiological stress markers allows complementing the subjective perspective of PwD ( Wuttke-Linnemann et al, 2019 , 2022 ). Particularly given the questionable validity of self-reports in PwD that may arise due to cognitive impairments resulting in anosognosia ( Wilson et al, 2016 ), physiological stress markers might enable the psychobiological stress experience to be captured more comprehensively.…”

“…In this regard, we recently found discrepancies between subjective and physiological markers of stress in PwD when evaluating the treatment success of a dyadic home-based psychosocial intervention. Whereas subjective stress did not decrease over time, PwD reported lower secretion of cortisol after each home visit ( Wuttke-Linnemann et al, 2022 ).…”

“…Empirical evidence on intervention effects as captured by physiological stress markers in PwD is in its beginning. The empirical evidence so far covers a wide and heterogenous range of interventions such as dyadic psychosocial intervention ( Wuttke-Linnemann et al, 2022 ), hand massage ( Schaub et al, 2018 ), acupressure ( Kwan et al, 2017 ), touch ( Woods et al, 2009 ), robot companions ( Liang et al, 2017 ), art interventions ( D’Cunha et al, 2019 ), music therapy ( Chu et al, 2014 ; de la Rubia Ortí et al, 2018 ), dance therapy ( Ho et al, 2020 ), or exercise ( Venturelli et al, 2016 ). Most often salivary cortisol is assessed as outcome measure with only few studies that simultaneously assessed salivary cortisol and salivary alpha-amylase ( Schaub et al, 2018 ; Wuttke-Linnemann et al, 2022 ).…”

“…The empirical evidence so far covers a wide and heterogenous range of interventions such as dyadic psychosocial intervention ( Wuttke-Linnemann et al, 2022 ), hand massage ( Schaub et al, 2018 ), acupressure ( Kwan et al, 2017 ), touch ( Woods et al, 2009 ), robot companions ( Liang et al, 2017 ), art interventions ( D’Cunha et al, 2019 ), music therapy ( Chu et al, 2014 ; de la Rubia Ortí et al, 2018 ), dance therapy ( Ho et al, 2020 ), or exercise ( Venturelli et al, 2016 ). Most often salivary cortisol is assessed as outcome measure with only few studies that simultaneously assessed salivary cortisol and salivary alpha-amylase ( Schaub et al, 2018 ; Wuttke-Linnemann et al, 2022 ). Methodological aspects vary among these studies considering the study population (severity of dementia), the setting of the study (hospital, nursing home, and home), the number of saliva samples obtained, sampling pattern and collection method, thus limiting comparisons across studies.…”

“…Nevertheless, in the majority studies point to beneficial effects on salivary cortisol, although often challenges with collecting sufficient valid saliva samples are reported ( Kwan et al, 2016 ). Beneficial effects present themselves by pre to post differences showing decreases in salivary cortisol after participation in a dyadic psychosocial intervention ( Wuttke-Linnemann et al, 2022 ), acupressure ( Schaub et al, 2018 ), hand massage ( Kwan et al, 2017 ), and exercise- and cognitive-based treatments ( Venturelli et al, 2016 ). Whereas one study finds decreases in salivary cortisol after music therapy ( de la Rubia Ortí et al, 2018 ), another one did not ( Chu et al, 2014 ).…”