Table_2_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：对于患有痴呆症（PwD）的个人及其非正式照护者（ICs）而言，住院治疗常常充满压力且负担沉重。日间诊所的治疗可能提供一种合适的替代方案，但常因痴呆症的确诊而被排除在外。此外，治疗成功的评估往往基于照护者的主观评价，而关于痴呆症患者自我报告的有效性则存在严重争议。因此，本研究旨在探讨在痴呆症患者及其照护者中应用心理生物应激指标的可能性，并评估在考虑日间诊所治疗环境和患者日常生活的基础上，治疗轨迹的可行性。方法：共有40对痴呆症患者（平均年龄：78.15 ± 6.80岁）及其照护者（平均年龄：63.85 ± 13.09岁）完成了纸质问卷（包括压力、抑郁症状、照护负担等），并测量了入院、出院及日间诊所治疗6个月后的头发皮质醇浓度（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，痴呆症患者及其照护者每天收集六份唾液样本，以分析唾液皮质醇（sCort）和α-淀粉酶（sAA）。结果：纸质问卷和HCC评估比门诊评估更可行。我们发现痴呆症患者主观和生理应激指标之间存在差异。尽管HCC随时间减少，但自我报告的压力却有所增加。儿童-父母对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均有所减少。在日常生活中，痴呆症患者及其照护者均表现出唾液皮质醇和α-淀粉酶的典型日间变化曲线，然而，我们没有发现唾液应激指标的时间综合指标存在差异。讨论：心理生物评价是可行的，并增加了信息价值，强调了生理应激指标在补充痴呆症患者压力自我报告和客观评估治疗轨迹方面的潜力。在本研究中，头发皮质醇浓度作为应激的生物标志物，其可行性和接受度高于唾液样本。关于治疗轨迹，我们发现对对子的影响存在差异，与配偶对相比，儿童-父母对从日间诊所治疗中获益更多。