Effects of Mindfulness Based Interventions in Adults and Older Adults Caregivers of Patients with Early Stage Alzheimer’s Disease: A Randomized Pilot Study

INTRODUCTION

Elderly people, more and more numerous, particularly in Italy, are often affected by one or more age-related diseases with a marked increase in degenerative brain diseases.

The consequence is that there is an increasing demand for assistance, which in Italy is mainly carried out by family members, with consequences on their psycho-physical balance.

This suggests the need to plan appropriate interventions to preserve their health, well-being, and quality of life (QoL) [1, 2]. This is of particular importance for caregivers (CGs) of patients affected by Alzheimer’s disease (AD-P) who are coping with all the troubling symptoms linked to the degeneration of personality of their AD family members (e.g., depression, agitation, wandering, aggression). These so-called neuropsychiatric symptoms create a significant burden for caregivers and are a source of great stress and depression [3, 4] with consequences on their psycho-physical health [1, 6].

Existing studies indicate that mindfulness-based interventions (MBIs) can be used to promote quality of life, and physical and mental health, and can be employed as primary and secondary preventive interventions for adults and older adults [7–11].

On the basis of these considerations, training with mindfulness-based stress reduction (MBSR) [10], one of the most widely used MBIs [10], was planned to favor the restoration and/or maintenance of the quality of life in these CGs. MBSR is evaluated in studies with clinical and non-clinical populations with positive effects on stress reduction improving quality of life through focused attention, meditation, cognitive restructuring, and adaptive learning techniques [11–13].

MBSR is a practice of effortless, non-judgmental attention to the psychic contents of the present moment, resulting in a reduction in rumination and promotion of a state of calm and quiet [11–18]. From this position of “observation without effort”, psychic contents and intrapsychic conflicts can be welcomed and integrated, managing to achieve a psycho-physical rebalancing [19–22].

Therefore, we believed that a practice with MBSR could help CGs to cope with stress and find strategies for positive adaptation to the difficult condition of caring for a patient with AD [23–25]. Moreover, we planned to make a long intervention of six months, believing that a short intervention (two, three months) was too short to address the difficulties of these CGs. This also started from the consideration that the degeneration of the sick family member’s personality is for them a trauma like mourning: the patient is no longer the known beloved one.

We believe that the group setting, foreseen in our intervention, is essential for the need for support and sharing of these CGs and constitutes another relevant aspect of our study.

Whether our treatment is effective it will be possible to propose MBSR it will be possible to propose MBSR as a treatment method for CGs of AD-P.

MATERIALS AND METHODS

RESULTS

The AD-P in the early stages have MMSE scores in the range of 18 to 26.

No differences emerged between the MBSR group and no-treatment group of CG for age, sex, educational level, health status, working conditions, caregiving reasons, and hours of caregiving (Table 1).

DISCUSSION

The effects of six-month MBSR training on AD-CGs quality of life, burden, and depression were evaluated. A random comparison was performed with a group of untreated caregivers.

MBI CGs show reduced stress due to the following AD-P neuropsychiatric symptoms: agitation-anxiety, euphoria, apathy-indifference, irritability, sleep disorders, eating disorders, and a tendency in depression. No effects on caregiver’s changes emerged in the following AD-P psychiatric disorders: delirium, hallucination, disinhibition, and aberrant motor behavior.

Furthermore, the MBSR CGs showed at the end of treatment an improvement of quality of life in particular in the following dimensions: general health, role limitation, emotional problem, energy-fatigue, emotional well-being, social well-being; while pain decreased.

Furthermore, depression decreased from medium-high to normal ranges. Overcoming the depressive state is one of the relevant results of this study and confirms the effectiveness of mindfulness practice, highlighted by other studies [35] in helping to overcome emotional difficulties, such as a negative decline in mood. It is interesting to highlight that as the dimensions of emotional and social well-being improve and as depression decreases, the dimension of pain also decreases. Some authors showed the practical efficacy of mindfulness in pain management precisely because it improves QoL [36] and consequently the physical functioning [37], particularly in patients with chronic pain.

We can state that the function of self-awareness, promoted by mindfulness training in treated CGs, which increases in our sample, is precisely that of creating an emotional rebalancing and mood stability that influences the perception of physical pain. Moreover, the practice of self-awareness (MBSR) with the discovering and listening of real needs allows the overcome of the maladaptive elements of one’s lifestyle, thus favoring the recovery of a good quality of life [38–40].

Our results can be explained by the mindfulness practice promoting an emotional-affective rebalancing. In this process, the caregiver finds within him/herself greater resources available to face and overcome the stress of the burden and satisfy his/her self-care needs.

On the other hand, the untreated CGs showed a worsening of physical functioning of QoL, while the other dimensions of QoL and burden remain unchanged. Thus, untreated CGs maintained a high burden and a general poor quality of life after six months. On the other hand, they showed an increase in time dependent burden and a reduction in QoL-physical functioning. The other dimensions of burden and quality of life remain unchanged.

CGs need some time to organize daily life based on the family member’s illness after first diagnosis and the signs of antisocial behavior. We hypothesize that they have difficulties and need outside help to reorganized their daily life on the basis of the patient’s need for assistance in order to create a minimum of adaptation and reduce the time dependent burden and the physical functioning.

In general, untreated CGs maintain a high burden and a poor quality of life after six months. The following consideration emerges from these results: it is right from the start of the diagnosis of AD in a family member that puts a strain on the psycho-physical balance of the family member. This suggests the need for these CGs for support at a much earlier stage of the disease (immediately after onset).

We think, through our interaction with the caregivers, that one of their reasons for great discomfort is the degeneration of the AD-P’s personality, which in addition to requiring a reorganization of daily life, involves considerable stress. The familiar with AD is no longer the known beloved one. We believe that interventions with CGs should address this issue.

This topic has been addresses in MBSR group. These CGs were helped to become aware of and rework the trauma of the patient’s personality degeneration.

In conclusion, our study demonstrates the efficacy of six months of Mindfulness training, in group setting, on improving the QoL and reducing the burden on caregivers of patients with early stage AD.

This suggests that the caregiver needs practical and emotional support to face on the onset of AD in a family member.

CREDIT AUTHOR STATEMENT

Maria Velia Giulietti (Conceptualization; Methodology; Resources; Writing – original draft); Paolo Fabbietti (Formal analysis); Roberta Spatuzzi (Methodology; Writing – original draft; Writing – review & editing); Anna Vespa (Conceptualization; Formal analysis; Methodology; Resources; Supervision; Writing – original draft; Writing – review & editing).