Alzheimer Caregiving and Autoimmune Diseases

  • November is National Alzheimer's Disease Awareness Month and National Family Caregivers Month. Check the websties of the National Alzheimer's Association  and the National Families Caregiver's Association for local Alzheimer's awareness events and activities in your area. To do our part HealthCentral is asking writers from our various sites to promote awareness of Alzheimer's disease and overlapping conditions. There is a clear link between caregiving for a person with Alzheimer's and autoimmune diseases and we have asked Lene Andersen from our rheumatoid arthritis site to look into this.


    Taking care of someone who has dementia is hard (this might be the understatement of the decade). This type of caregiving causes chronic stress so intense that it has a direct effect on your body's ability to support you. Alzheimer caregivers have a higher risk of depression and heart disease, have a harder time fighting infection, their wound healing is delayed and vaccinations don't work as well as in others. These last three aspects indicate an impaired immune response. What happens within your body when you are under this kind of chronic stress? And what is the connection to autoimmune diseases?

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    Stress and Your Body

    Stress triggers a physiological reaction in your body as a result of a perceived threat - this is an automatic response left over from the days of sabertooth tigers. These days we don't often run into large cats looking for a person-sized snack, but the response remains and is similar in situations of  physical or emotional stress.


    When you're under stress, it triggers the release of stress hormones and immune system proteins, one of which is called interleukin 6 (IL-6). Researchers at Ohio State University Medical Center discovered that the chronic stress of caregiving caused IL-6 to increase four times more than in non-caregiving individuals. And this is where it gets really interesting and relevant to your life because IL-6 is linked to an impaired immune system response in older adults.


    The Role of IL-6

    IL-6 is part of a group of protein molecules called cytokines that play an important role in the body's immune response.. This group also includes IL-1, IL-8 and TNF (tumor necrosis factor). During periods of stress, they kick into a process that increases inflammation in order to direct blood cells to the site of an injury or infection. This is part of the body's response to events that will require it to heal. However, when this response happens over and over again as it does in chronic stress, it causes the body to maintain high levels of IL-6 as well as other hormones and cytokines. Prolonged high levels of IL-6 has been linked to a host of illnesses and conditions, among them cardiovascular disease, type II diabetes, frequent viral infections and autoimmune diseases such as rheumatoid arthritis (RA), lupus and MS.


    Autoimmune Diseases

    Your immune system protects your against illness and infection. Its job is to attack infection and foreign invaders in your body such as bacteria or viruses so you can get better. However, when you have an autoimmune disease, your immune system is confused and treats your own healthy cells as an invader. How this attack will be expressed depends on which autoimmune disease you have. For instance, in RA, the immune response of inflammation that normally helps heal a wound is directed to the joints and in multiple sclerosis, the immune system attacks the myelin (a sheath that surrounds nerve fibers).


    Autoimmune diseases are difficult to treat and only recently has there been significant advances in treatment, although there still is no cure. These new treatments are geared towards inhibiting certain cytokines which seems to block the immune system from its impaired response. For instance, the biologic medications developed in the past 12-15 years to treat RA focus on blocking TNF (Enbrel, Humira and others), IL-1 (Kineret) and IL-6 (Actemra). These medications offer more hope for effective treatment that there ever has been before, but life with a chronic autoimmune disease remains a difficult one.

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    How to Protect Yourself

    What triggers the immune response that leads to the development of an autoimmune disease is still not fully understood. It involves a combination of genetic and environmental factors that work together in a sort of perfect storm, resulting in an autoimmune disease. It's not possible to predict who will develop such an illness and won't, so prevention is no simple as carrying a bottle of hand sanitizer to avoid catching a cold.


    We do know that the stress response appears to be one of the factors involved in triggering autoimmune and other diseases. Therefore, there may be some benefit in finding ways of reducing the intense, chronic stress of providing care for a loved one was Alzheimer's.. At minimum, such strategies will enable you to cope better and perhaps they may also help to decrease your body's stress response. Some of these strategies can include the following:

    • Make yourself aware of the Caregiver' Bill of Rights, a wonderful document that validates the fact that you matter, too. Reminding yourself that you have a right to stay healthy and to meet your own needs is incredibly important. Remember that if you don't take care of yourself, you won't be able to take care of others.
    • Stay informed. The more you know about what to expect in taking care of someone with dementia, the better able you are to reduce the stress of the experience. Our Caregiver Center is a great place to start.
    • Ask for help. If possible, talk to other family members about a more even distribution of caregiving. Ask your friends if they would be willing to help occasionally - by staying with your family member what you go grocery shopping or simply have a good chat with you on the phone. If you can afford it, hire someone to be with your loved one, even if it's only for a few hours a week. Speak to your doctor about help available in the community, such as day programs or respite programs. Getting a break - even a small one - on a regular basis, can do wonders for your health and well-being.
    • Plan for the future. At some point, it will likely be necessary for you to find a place, such as a nursing home, where your family member can receive around the clock care. This can be especially important for people who have a need to wander or who are at the later stage Alzheimer's. Making this decision is very difficult. Doing your research in advance will mean making better decisions when the time comes.
    • Remove other types of stress from your life. This is easy to say and much harder to do. However, having the goal of at least reducing other types of stress will put the issue on your radar and make it easier to address.
    • Find support from other caregivers. Connecting with other people in the same situation can be a liberating and empowering experience. There may be an Alzheimer's caregiver support group in your area, but if there isn't, connect online. Not only will you receive valuable support from people who owe understand what you're going through, but such groups and communities are also excellent sources of practical tips.

    Caregiving for someone with dementia wears on you physically and emotionally and can isolate you from others at a time when you need connection to your community the most. Reach out, even when you're exhausted. The better you manage your stress, the more you protect your health.


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    Lene Andersen is the author of the award-winning blog The Seated View.

Published On: November 14, 2011