Skip to main content Accessibility help

Physiological and functional consequences of caregiving for relatives with dementia

  • Irina Fonareva (a1) and Barry S. Oken (a2)



Chronic stress negatively affects health and well-being. A growing population of informal dementia caregivers experience chronic stress associated with extraordinary demands of caring for a relative with dementia. This review summarizes physiological and functional changes due to chronic dementia caregiver stress.


A literature search for papers assessing effects of dementia caregiving was conducted focusing on publications evaluating differences between caregivers and non-caregivers in objective measures of health and cognition.


The review identified 37 studies describing data from 4,145 participants including 749 dementia caregivers and 3,396 non-caregiver peers. Objective outcome measures affected in dementia caregivers included markers of dyscoagulation, inflammation, and cell aging as well as measures of immune function, sleep, and cognition. Though diverse in designs, samples, and study quality, the majority of the studies indicated increased vulnerability of dementia caregivers to detrimental changes in health and cognition. Demographic and personality characteristics moderating or mediating effects of chronic stress in caregivers were also reviewed.


There is accumulating evidence that chronic dementia caregiver stress increases their vulnerability to disease and diminishes their ability to provide optimal care. Clinicians and society need to appreciate the extent of deleterious effects of chronic stress on dementia caregiver health.


Corresponding author

Correspondence should be addressed to: Barry S. Oken, MD, Oregon Health & Science University, Mail Code CR120, 3181 SW Sam Jackson Park Road, Portland, Oregon 97239, USA. Phone: +503-494-8873; Fax: +503-494-9520. Email:


Hide All
Aschbacher, K. et al. (2005). Coping processes and hemostatic reactivity to acute stress in dementia caregivers. Psychosomatic Medicine, 67, 964971.
Brummett, B. H. et al. (2005). Neighborhood characteristics moderate effects of caregiving on glucose functioning. Psychosomatic Medicine, 67, 752758.
Brummett, B. H. et al. (2008). HPA axis function in male caregivers: effect of the monoamine oxidase-A gene promoter (MAOA-uVNTR). Biological Psychology, 79, 250255.
Castro, C. M. et al. (2009). Sleep patterns and sleep-related factors between caregiving and non-caregiving women. Behavioral Sleep Medicine, 7, 164179.
Caswell, L. W. et al. (2003). Negative associations of chronic stress and cognitive performance in older adult spouse caregivers. Experimental Aging Research, 29, 303318.
Clark, M. C., Nicholas, J. M., Wassira, L. N. and Gutierrez, A. P. (2011). Psychosocial and biological indicators of depression in the caregiving population. Biological Research for Nursing. Available at:; last accessed 15 February 2012.
Damjanovic, A. K. et al. (2007). Accelerated telomere erosion is associated with a declining immune function of caregivers of Alzheimer's disease patients. Journal of Immunology, 179, 42494254.
de Vugt, M. E. et al. (2005). Behavioral problems in dementia patients and salivary cortisol patterns in caregivers. The Journal of Neuropsychiatry and Clinical Neurosciences, 17, 201207.
de Vugt, M. E. et al. (2006). Cognitive functioning in spousal caregivers of dementia patients: findings from the prospective MAASBED study. Age and Ageing, 35, 160166.
Epel, E. S. et al. (2010). Dynamics of telomerase activity in response to acute psychological stress. Brain, Behavior, and Immunity, 24, 531539.
Fauth, E. et al. (2012). Caregivers’ relationship closeness with the person with dementia predicts both positive and negative outcomes for caregivers’ physical health and psychological well-being. Aging Ment Health, 16, 699711.
Fonareva, I., Amen, A. M., Ellingson, R. M. and Oken, B. S. (2012). Differences in stress-related ratings between research center and home environments in dementia caregivers using ecological momentary assessment. International Psychogeriatrics, 24, 19.
Fonareva, I., Amen, A. M., Zajdel, D. P., Ellingson, R. M. and Oken, B. S. (2011). Assessing sleep architecture in dementia caregivers at home using an ambulatory polysomnographic system. Journal of Geriatric Psychiatry and Neurology, 24, 5059.
Gouin, J. P., Glaser, R., Malarkey, W. B., Beversdorf, D. and Kiecolt-Glaser, J. (2012). Chronic stress, daily stressors, and circulating inflammatory markers. Health Psychology, 31, 264268.
Kiecolt-Glaser, J. K. et al. (2003). Chronic stress and age-related increases in the proinflammatory cytokine IL-6. Proceedings of the National Academy of Sciences of the United States of America, 100, 90909095.
Kiecolt-Glaser, J. K. et al. (2011). Childhood adversity heightens the impact of later-life caregiving stress on telomere length and inflammation. Psychosomatic Medicine, 73, 1622.
Mausbach, B. T. et al. (2007). Spousal caregivers of patients with Alzheimer's disease show longitudinal increases in plasma level of tissue-type plasminogen activator antigen. Psychosomatic Medicine, 69, 816822.
Mausbach, B. T. et al. (2008). A 5-year longitudinal study of the relationships between stress, coping, and immune cell beta(2)-adrenergic receptor sensitivity. Psychiatry Research, 160, 247255.
Mausbach, B. T. et al. (2010). Association between chronic caregiving stress and impaired endothelial function in the elderly. Journal of the American College of Cardiology, 55, 25992606.
McCallum, T. J., Sorocco, K. H. and Fritsch, T. (2006). Mental health and diurnal salivary cortisol patterns among African American and European American female dementia family caregivers. The American Journal of Geriatric Psychiatry, 14, 684693.
McKibbin, C. L. et al. (2005). Sleep in spousal caregivers of people with Alzheimer's disease. Sleep, 28, 12451250.
Mills, P. J. et al. (2004). Vulnerable caregivers of Alzheimer disease patients have a deficit in beta 2-adrenergic receptor sensitivity and density. The American Journal of Geriatric Psychiatry, 12, 281286.
Mills, P. J. et al. (2009). Effects of gender and dementia severity on Alzheimer's disease caregivers’ sleep and biomarkers of coagulation and inflammation. Brain, Behavior, and Immunity, 23, 605610.
Norton, M. C. et al. (2010). Greater risk of dementia when spouse has dementia? The Cache County study. Journal of the American Geriatrics Society, 58, 895900.
O'Donovan, A. et al. (2012). Stress appraisals and cellular aging: a key role for anticipatory threat in the relationship between psychological stress and telomere length. Brain, Behavior, and Immunity, 26, 573579.
Oken, B. S., Fonareva, I. and Wahbeh, H. (2011). Stress-related cognitive dysfunction in dementia caregivers. Journal of Geriatric Psychiatry and Neurology, 24, 191198.
Palma, K. A. et al. (2011). Emotional memory deficit and its psychophysiological correlate in family caregivers of patients with dementia. Alzheimer Disease and Associated Disorders, 25, 262268.
Roepke, S. K. et al. (2008). Personal mastery is associated with reduced sympathetic arousal in stressed Alzheimer caregivers. The American Journal of Geriatric Psychiatry, 16, 310317.
Roepke, S. K. et al. (2011a). Carotid plaque in Alzheimer caregivers and the role of sympathoadrenal arousal. Psychosomatic Medicine, 73, 206213.
Roepke, S. K. et al. (2011b). Effects of Alzheimer caregiving on allostatic load. Journal of Health Psychology, 16, 5869.
Rowe, M. A., McCrae, C. S., Campbell, J. M., Benito, A. P. and Cheng, J. (2008). Sleep pattern differences between older adult dementia caregivers and older adult noncaregivers using objective and subjective measures. Journal of Clinical Sleep Medicine, 4, 362369.
Schoenmakers, B., Buntinx, F. and Delepeleire, J. (2010). Factors determining the impact of care-giving on caregivers of elderly patients with dementia. A systematic literature review. Maturitas, 66, 191200.
Segerstrom, S. C., Schipper, L. J. and Greenberg, R. N. (2008). Caregiving, repetitive thought, and immune response to vaccination in older adults. Brain, Behavior, and Immunity, 22, 744752.
Thorpe, J. M. et al. (2006). Caregiver psychological distress as a barrier to influenza vaccination among community-dwelling elderly with dementia. Medical Care, 44, 713721.
Tomiyama, A. J. et al. (2012). Does cellular aging relate to patterns of allostasis? An examination of basal and stress reactive HPA axis activity and telomere length. Physiology & Behavior, 106, 4045.
Tschanz, J. T. et al. (2013) Caregiver Coping Strategies Predict Cognitive and Functional Decline in Dementia: The Cache County Dementia Progression Study. Am J Geriatr Psychiatry, 21, 5766.
Vitaliano, P. P., Zhang, J. and Scanlan, J. M. (2003). Is caregiving hazardous to one's physical health? A meta-analysis. Psychological Bulletin, 129, 946972.
Vitaliano, P. P. et al. (2005). Psychophysiological mediators of caregiver stress and differential cognitive decline. Psychology and Aging, 20, 402411.
Vitaliano, P. P. et al. (2009). Depressed mood mediates decline in cognitive processing speed in caregivers. Gerontologist, 49, 1222.
von Kanel, R. et al. (2005). Exaggerated plasma fibrin formation (D-dimer) in elderly Alzheimer caregivers as compared to noncaregiving controls. Gerontology, 51, 713.
von Kanel, R. et al. (2008). Increased Framingham coronary heart disease risk score in dementia caregivers relative to non-caregiving controls. Gerontology, 54, 131137.
von Kanel, R. et al. (2010). Sleep and biomarkers of atherosclerosis in elderly Alzheimer caregivers and controls. Gerontology, 56, 4150.
von Kanel, R. et al. (2011). Regular physical activity moderates cardiometabolic risk in Alzheimer's caregivers. Medicine and Science in Sports and Exercise, 43, 181189.
von Kanel, R. et al. (2012a). Effect of Alzheimer caregiving on circulating levels of C-reactive protein and other biomarkers relevant to cardiovascular disease risk: a longitudinal study. Gerontology, 58, 354365.
von Kanel, R. et al. (2012b). Effect of chronic dementia caregiving and major transitions in the caregiving situation on kidney function: a longitudinal study. Psychosomatic Medicine, 74, 214220.
von Kanel, R. et al. (2012c). Sleep in spousal Alzheimer caregivers: a longitudinal study with a focus on the effects of major patient transitions on sleep. Sleep, 35, 247255.
Wahbeh, H., Kishiyama, S. S., Zajdel, D. and Oken, B. S. (2008). Salivary cortisol awakening response in mild Alzheimer disease, caregivers, and noncaregivers. Alzheimer Disease and Associated Disorders, 22, 181183.



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed