Evaluating Patient Brain and Behavior Pathways to Caregiver Health in Neurodegenerative Diseases

Abstract

Background: Caregivers of patients with neurodegenerative diseases are at heightened risk for serious health problems, but health differences between individual caregivers abound.

Aims: To determine whether atrophy in patient brains could be used to identify caregivers at heightened risk for health problems and which patient variables mediate this relationship.

Methods: In 162 patient-caregiver dyads, we assessed patient atrophy using structural MRI, caregiver health, and patient behavior and cognitive symptoms.

Results: Patient atrophy in the right insula and medial frontal gyrus was associated with worse caregiver health; this relationship was partially mediated by patient neuropsychiatric symptoms, and assessing atrophy in these regions improved predictions of poor caregiver health above and beyond patient behavioral symptoms.

Conclusions: This study shows the value of patients' brain data in identifying caregivers at risk for becoming sick themselves.

Keywords: Caregiver health; Neurodegenerative disease; Patient behavioral symptoms; Patient cognitive symptoms; Voxel-based morphometry.

Fig. 1.

Consistent neural correlates of worse caregiver health. T-score maps of brain areas for which a smaller volume in patient and healthy control brains is associated with greater severity of caregiver psychopathological symptoms and worse caregiver global health (p < 0.005, uncorrected). The T-score maps overlap in the right ventral anterior insula and in the superior medial frontal gyrus. The results for all analyses are overlaid on an MNI template brain.

Fig. 2.

Behavioral symptoms as a mediator. Regression coefficients and standard error (SE) for the relationship between patient brain volumes (right ventral anterior insula and superior medial frontal gyrus) and caregiver psychopathology as mediated by patient behavioral symptoms on the Neuropsychiatric Inventory. * p < 0.05, ** p < 0.01.