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Chronic stress in elderly carers of dementia patients and antibody response to influenza vaccination.

Abstract

BACKGROUND

There are many reports of psychological morbidity in spousal carers of patients with dementia. The consequences of this increased stress on the immune system are unclear. We investigated whether antibody responses to influenza vaccination differed between carers and a control group, and the relation of the antibody response to the hypothalamic-pituitary-adrenal (HPA) axis.

METHODS

50 spousal carers of dementia patients, median age 73 years (IQR 66-77), and 67 controls (68 years [66-71]) of similar socioeconomic status were enrolled. Anxiety and depression were measured by the Savage Aged Personality Screening Scale and stress by the Global Measure of Perceived Stress scale. Principal-component analysis was used to yield a summary score of emotional distress from these two scales. Salivary cortisol concentrations were measured over a single day at three times (0800-1000, 1100-1300, and 2000-2200). Participants received a trivalent influenza vaccine and IgG antibody titres to each strain were measured on days 0, 7, 14, and 28.

FINDINGS

Mean scores of emotional distress were significantly higher in carers at each time point than in controls (all p<0.0003). Mean (SD) salivary cortisol concentrations, calculated as area under the curve (AUC), were higher in carers than controls at all three assessments (6 months 16.0 [8.0] vs 11.2 [4.4], p=0.0001; respectively). Eight (16%) of 50 carers and 26 (39%) of 67 controls had a four-fold increase in at least one of the IgG titres (p=0.007). There was an inverse relation between AUC cortisol and IgG antibody titre to the Nanchang strain that was significant on day 14 (r=-0.216, p=0.039).

INTERPRETATION

Elderly carers of spouses with dementia have increased activation of the hypothalamic-pituitary-adrenal axis and a poor antibody response to influenza vaccine. Carers may be more vulnerable to infectious disease than the population of a similar age.

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  • Authors+Show Affiliations

    ,

    Department of Medicine, University of Bristol, UK. K.Vedhara@bristol.ac.uk

    , , , , , ,

    Source

    Lancet (London, England) 353:9153 1999 Feb 20 pg 627-31

    MeSH

    Aged
    Analysis of Variance
    Antibodies, Viral
    Anxiety
    Area Under Curve
    Caregivers
    Chronic Disease
    Dementia
    Depression
    Female
    Follow-Up Studies
    Humans
    Hydrocortisone
    Hypothalamo-Hypophyseal System
    Immunoglobulin G
    Influenza A virus
    Influenza B virus
    Influenza Vaccines
    Male
    Pituitary-Adrenal System
    Saliva
    Social Class
    Spouses
    Stress, Physiological
    Stress, Psychological

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    10030328

    Citation

    Vedhara, K, et al. "Chronic Stress in Elderly Carers of Dementia Patients and Antibody Response to Influenza Vaccination." Lancet (London, England), vol. 353, no. 9153, 1999, pp. 627-31.
    Vedhara K, Cox NK, Wilcock GK, et al. Chronic stress in elderly carers of dementia patients and antibody response to influenza vaccination. Lancet. 1999;353(9153):627-31.
    Vedhara, K., Cox, N. K., Wilcock, G. K., Perks, P., Hunt, M., Anderson, S., ... Shanks, N. M. (1999). Chronic stress in elderly carers of dementia patients and antibody response to influenza vaccination. Lancet (London, England), 353(9153), pp. 627-31.
    Vedhara K, et al. Chronic Stress in Elderly Carers of Dementia Patients and Antibody Response to Influenza Vaccination. Lancet. 1999 Feb 20;353(9153):627-31. PubMed PMID: 10030328.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Chronic stress in elderly carers of dementia patients and antibody response to influenza vaccination. AU - Vedhara,K, AU - Cox,N K, AU - Wilcock,G K, AU - Perks,P, AU - Hunt,M, AU - Anderson,S, AU - Lightman,S L, AU - Shanks,N M, PY - 1999/2/25/pubmed PY - 1999/2/25/medline PY - 1999/2/25/entrez SP - 627 EP - 31 JF - Lancet (London, England) JO - Lancet VL - 353 IS - 9153 N2 - BACKGROUND: There are many reports of psychological morbidity in spousal carers of patients with dementia. The consequences of this increased stress on the immune system are unclear. We investigated whether antibody responses to influenza vaccination differed between carers and a control group, and the relation of the antibody response to the hypothalamic-pituitary-adrenal (HPA) axis. METHODS: 50 spousal carers of dementia patients, median age 73 years (IQR 66-77), and 67 controls (68 years [66-71]) of similar socioeconomic status were enrolled. Anxiety and depression were measured by the Savage Aged Personality Screening Scale and stress by the Global Measure of Perceived Stress scale. Principal-component analysis was used to yield a summary score of emotional distress from these two scales. Salivary cortisol concentrations were measured over a single day at three times (0800-1000, 1100-1300, and 2000-2200). Participants received a trivalent influenza vaccine and IgG antibody titres to each strain were measured on days 0, 7, 14, and 28. FINDINGS: Mean scores of emotional distress were significantly higher in carers at each time point than in controls (all p<0.0003). Mean (SD) salivary cortisol concentrations, calculated as area under the curve (AUC), were higher in carers than controls at all three assessments (6 months 16.0 [8.0] vs 11.2 [4.4], p=0.0001; respectively). Eight (16%) of 50 carers and 26 (39%) of 67 controls had a four-fold increase in at least one of the IgG titres (p=0.007). There was an inverse relation between AUC cortisol and IgG antibody titre to the Nanchang strain that was significant on day 14 (r=-0.216, p=0.039). INTERPRETATION: Elderly carers of spouses with dementia have increased activation of the hypothalamic-pituitary-adrenal axis and a poor antibody response to influenza vaccine. Carers may be more vulnerable to infectious disease than the population of a similar age. SN - 0140-6736 UR - https://www.unboundmedicine.com/medline/citation/10030328/Chronic_stress_in_elderly_carers_of_dementia_patients_and_antibody_response_to_influenza_vaccination_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0140-6736(98)06098-X DB - PRIME DP - Unbound Medicine ER -