Table_1_Psychobiological Evaluation of Day Clinic Treatment for People Living With Dementia – Feasibility and Pilot Analyses.docx

BackgroundHospitalization is often stressful and burdensome for people living with dementia (PwD) and their informal caregivers (ICs). Day clinic treatment may provide a suitable alternative, but is often precluded by a diagnosis of dementia. Furthermore, it is often caregiver-based ratings that measure treatment success as the validity of self-reports in PwD is critically discussed. We therefore set out to examine the feasibility of psychobiological stress measures in PwD and ICs and to evaluate treatment trajectories considering both the day clinic context and the daily life of the dyads.MethodA total of 40 dyads of PwD (mean age: 78.15 ± 6.80) and their ICs (mean age: 63.85 ± 13.09) completed paper-and-pencil questionnaires (covering stress, depressive symptoms, and caregiver burden among others) in addition to the measurement of hair cortisol concentrations (HCC) at admission, discharge, and follow-up 6 months after day clinic treatment. As part of an ambulatory assessment, for 2 days at the beginning and 2 days at the end of the day clinic treatment, PwD and ICs collected six saliva samples per day for the analysis of salivary cortisol (sCort) and alpha-amylase (sAA).ResultsPaper-and-pencil questionnaires and HCC assessments were more feasible than the ambulatory assessment. We found discrepancies between subjective and physiological markers of stress in PwD. Whereas HCC decreased over time, self-reported stress increased. Child–parent dyads reported decreases in neuropsychiatric symptoms, associated burden, and self-reported stress from admission to follow-up. In daily life, both PwD and ICs showed characteristic diurnal profiles of sAA and sCort, however, we found no differences in summary indicators of salivary stress markers over time.DiscussionThe psychobiological evaluation was feasible and added informative value, underlining the potential of physiological stress markers to complement self-reports on stress in PwD and to objectively evaluate treatment trajectories. In this sample, HCC was more feasible and acceptable as biological marker of stress compared to saliva samples. Concerning treatment trajectories, differential effects on the dyads were found, with child–parent dyads benefiting more from day clinic treatment compared to spousal dyads.

背景：痴呆症（PwD）患者的住院背景通常对个人及其非正式护理者（ICs）构成压力和负担。日间诊所治疗可能提供一种合适的替代方案，但常因痴呆症的诊断而受阻。此外，治疗成功的衡量往往依赖于护理者的主观评价，而痴呆症患者自我报告的有效性则备受争议。因此，本研究旨在探讨在痴呆症患者及其护理者中应用心理生物应激指标的可行性，并评估考虑日间诊所治疗背景及伴侣日常生活状况的治疗轨迹。方法：共有40对痴呆症患者（平均年龄：78.15 ± 6.80岁）及其护理者（平均年龄：63.85 ± 13.09岁）完成了纸质问卷（包括压力、抑郁症状和护理者负担等内容），并在入院、出院以及日间诊所治疗6个月后的随访期间测量了毛发皮质醇浓度（HCC）。作为门诊评估的一部分，在日间诊所治疗开始和结束的前后两天，痴呆症患者及其护理者每日收集六次唾液样本，用于唾液皮质醇（sCort）和α-淀粉酶（sAA）的分析。结果：纸质问卷和HCC评估比门诊评估更具可行性。我们发现痴呆症患者的主观和生理应激指标之间存在差异。尽管HCC随时间下降，但自我报告的压力感却有所上升。儿童-父母伴侣报告从入院到随访期间神经精神症状、相关负担和自我报告的压力感均有所降低。在日常生活中，痴呆症患者和护理者均表现出sAA和sCort的特征性日节律，然而，我们在唾液应激标志物的总结指标上并未发现随时间的变化。讨论：心理生物评估具有可行性并提供了有价值的信息，强调了生理应激标志物在补充痴呆症患者压力自我报告及客观评估治疗轨迹方面的潜力。在本研究中，与唾液样本相比，HCC作为应激生物标志物更为可行和可接受。关于治疗轨迹，我们发现伴侣对日间诊所治疗的反应存在差异，儿童-父母伴侣比配偶伴侣更能从中获益。