Exaggerated Plasma Fibrin Formation (D-Dimer) in Elderly Alzheimer Caregivers as Compared to Noncaregiving Controls

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Abstract
Background: The chronic stress of providing care for a spouse suffering from Alzheimer’s disease has been associated with an increased risk for coronary artery disease and overall mortality. Procoagulant changes are kindled by mental stress, and they are prospectively associated with atherothrombotic events. Objective: To examine whether dementia caregivers would show greater coagulation activity and less fibrinolytic capacity than noncaregiving controls. Methods: Subjects were 48 (30 female and 18 male) elderly (mean age ± SD, 72 ± 9 years) community-dwelling spousal Alzheimer caregivers and 20 noncaregiving age- and gender-matched controls. Plasma levels of thrombin-antithrombin III, fibrin D-dimer, von Willebrand factor, tissue-type plasminogen activator, and plasminogen activator inhibitor 1 were measured. Results: D-dimer, a marker of fibrin formation and degradation, was significantly higher in caregivers than in controls (688 ± 575 vs. 406 ± 157 ng/ml, p = 0.021). Plasma levels of the four other hemostasis variables were not significantly different between the two groups. Controlling for the classic cardiovascular risk factors body mass index, hypertension status, smoking status, hypercholesterolemia, type II diabetes, and medication potentially affecting hemostasis did not change results. Conclusion: The findings suggest that Alzheimer caregivers have an increased fibrin turnover as compared to noncaregiving controls independent of common confounders of hemostasis. Such an elevated clotting diathesis might contribute to increased cardiovascular risk and overall mortality with dementia caregiving strain.