Caregiver Vulnerability and Brain Structural Markers: Compounding Risk.

Caregiving strain confers an increased risk for allcause mortality. Intensive caregiving can produce a range of adverse mental and physical health consequences, best documented among dementia family caregivers. The provocative population-based study of the elderly by Smagula and colleagues, drawn from a random, stratified sample, showed that more than 82% of those spouses who helped their partner with four or more of the 12 activities of daily living (ADLs) or instrumental activities of daily living (IADLs) reported strain, consistent with other literature. Caregivers who helped their partner with three or fewer IADLs, however, were 55% more likely to report strain if they had magnetic resonance imaging–assessed white matter grades of 4 or greater. This latter finding is quite novel and raises the question of whether brain structural pathology may augment caregiver strain for some individuals. The findings are particularly notable in view of the very broad definition used for caregiving: These researchers only required that the impaired spouse have difficulty with at least one ADL or IADL, “due to physical or health problems or problems with confusion.” Accordingly, it is likely that their sample was considerably less burdened and less distressed than the caregivers who have received the most attention: spousal caregivers for dementia sufferers, the population most heavily represented in the studies they cite. Furthermore, their research participants only needed to meet criteria as caregivers at a single time point, so that spouses who were only functioning as temporary or transient caregivers following a partner’s acute medical problems would nonetheless be classified as caregivers in their data. As a consequence of these factors, their data are likely to underestimate the actual impact of caregiving for a severely physically or cognitively disabled spouse among individuals with brain structural pathology.