Aspectos psiconeuroimunológicos de idosos cuidadores de pacientes com demência

• Ano de defesa: 2006
• Autor(a) principal: Jeckel, Cristina Maria Moriguchi
• Orientador(a): Bauer, Moisés Evandro
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Pontifícia Universidade Católica do Rio Grande do Sul; Porto Alegre
• Palavras-chave em Português: PSICONEUROIMUNOLOGIA; IDOSOS (PSICOLOGIA); MEDICINA PSICOSSOMÁTICA
• Link de acesso: http://hdl.handle.net/10923/3568

Introduction: The daily care of demented patients constitutes a naturalistic model of chronic stress and may accelerate age-related changes. Changes in both immunological and endocrine profiles (e. g. higher cortisol levels, reduced T lymphocyte proliferation, increased inflammatory cytokines) have been reported in previous studies paralleling the emotional distress. The aim of this investigation is to evaluate how the chronic stress of daily caregiving for an Alzheimer patient could impact on the psychoneuroimmunological aspects observed during the healthy aging process. Methods: Forty one caregivers between 40 to 82 years old (60. 56 ± 1. 81) and 33 healthy controls between 40 to 90 years old (60. 27 ± 2. 46) were recruited accordingly the SENIEUR protocol. Depression, anxiety, stress and coping inventories were used to measure emotional distress and strategies of coping to perceived stress. Salivary cortisol levels were measured across the day (8h, 12h and 20h) and dehydroepiandrostenone sulphate (DHEAS) measured in the morning (8h). Peripheral blood samples were collected in the morning to evaluate T-cell proliferation and sensitivity to glucocorticoids (dexamethasone, DEX; corticosterone, CORT). Dexamethasone- suppresion test was performed by the administration of evening DEX (one mg, P. O. ) and measurement of salivary cortisol in the following morning. Results: The caregivers were more anxious, depressed and stressed than controls, in the absence of increasing salivary cortisol levels. The most frequent coping strategies were social support, positive reevaluation and problem solving. The salivary DHEAS levels were significantly lower in the caregivers compared to controls, leading to a higher cortisol/DHEAS ratio. We observed a significantly higher proportion of DEX non-suppressors within the caregiving group (29. 3%) compared to healthy controls (3%). The caregivers had an increased lymphocyte proliferation, higher sensibility to CORT and resistance to DEX in vitro. Conclusions: The chronic stress may accelerate age-related changes, including higher cortisol/ DHEAS ratio and altered cellular sensitivity to glucocorticoids. However, the excellent health status (SENIEUR) may protect the chronic stressed individuals from damaging cortisol- related effects. It is also important to consider that inter-individual variability could interfere on the interactions between the biological, psychological and social factors.