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Alzheimer caregiving stress and atherosclerotic disease : psychosocial and physiological pathways linking chronic stress to disease


One in eight Americans over the age of 65 is diagnosed with Alzheimer's disease and the annual incidence is expected to double by the year 2050. Unpaid family caregivers provide 80% of the healthcare for these individuals. Extensive research suggests that caregiving takes a substantial toll on health and is associated with increased coronary heart disease risk. Recent evidence suggests that chronic stress associated with caregiving may accelerate the atherosclerotic disease process. Although the processes driving such consequences are complex, heightened sympatho-adrenal-medullary (SAM) axis arousal and inflammation represent potential mechanisms linking stress to atherosclerosis. A conceptual framework modeling the translation of caregiving stress to downstream evidence of atherosclerosis was formulated. The present study aimed to determine if this model represented a parsimonious and valid characterization of observed data from a sample of 126 Alzheimer caregivers. In brief, this model specified a positive relationship between stress and markers of atherosclerosis with SAM arousal and inflammation as mediators. Coping resources were expected to buffer the relationship between caregiving stress and physiologic mediators. Confirmatory factor analysis was used to test latent variable measurement models and regression was used to assess structural relationships. Exploratory analyses assessed the impact of stress and coping on atherosclerotic progression over time. Results indicated that caregiving stress was unassociated with evidence of atherosclerosis and neither SAM arousal nor inflammation mediated this relationship. Coping did not moderate the relationship between stress and atherosclerosis or physiologic mediators. However, coping was associated with reduced SAM arousal and inflammation. Longitudinal analyses suggested that higher use of problem -focused coping was significantly associated with slower atherosclerotic progression. In sum, this comprehensive model did not fit the observed data in this sample, possibly due to power limitations and strength of measurement models. However, prior work in this cohort of caregivers does support specific components of this model. Longitudinal analyses suggested that problem-focused coping was associated with slower atherosclerotic progression, a finding that converges with past research suggesting that active coping strategies have a beneficial impact on cardiovascular health. Future work might examine the impact of coping skills training on atherosclerotic progression

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