Assessing stress using repeated saliva concentration of steroid hormones in dementia care dyads: results from a controlled pilot care music intervention
Abstract
Background: Stress-related biomarkers have the potential to provide objective measures of whether interventions directed at people with dementia (PWD) and their family caregivers (FCG) are successful. The use of such biomarkers has been limited by logistical barriers to sample collection.
Objective: Explore saliva concentration of steroid hormones in dementia care dyads during a music intervention.
Methods: Consecutive PWD attending a memory evaluation center and their FCG were allocated to either an intervention-with-music or a non-intervention control group. All were living at home. Stress biomarkers, salivary cortisol and dehydroepiandrosterone sulfate (DHEA-S) samples were collected by the PWD and their FCG, in the morning and evening, 5 days a week, for 8 consecutive weeks. Biomarker concentrations of the intervention and the control groups were compared at week 8, in an intention-to-treat approach with adjustment for baseline value.
Results: Twenty-four PWD in the intervention group and 10 in the control group, and their FCG were included in the analyses. The mean number of morning saliva collections was similar in the intervention and the control groups, ranging from 4.3 to 4.9 per participant weekly during the first 7 weeks, declining to 3.3 during week 8. Median log morning cortisol (pg/mL) among caregivers was lower in the intervention group than in the control group (8.09 vs. 8.57, P = 0.0133).
Conclusion: This study demonstrates that music intervention was associated with lower morning saliva cortisol concentrations for FCGs.
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References
2. Førsund LH, Grov EK, Helvik AS, Juvet LK, Skovdahl K, Eriksen S. The experience of lived space in persons with dementia: a systematic meta-synthesis. BMC Geriatr. 2018;18:33. doi: 10.1186/s12877-018-0728-0
3. Low LF, Fletcher J. Models of home care services for persons with dementia: a narrative review. Int Psychogeriatr. 2015;27:1593–600. doi: 10.1017/S1041610215000137
4. Gouin JP, Hantsoo L, Kiecolt-Glaser JK. Immune dysregulation and chronic stress among older adults: a review. Neuroimmunomodulation. 2008;15:251–9. doi: 10.1159/000156468
5. Brown KW, Coogle CL, Wegelin J. A pilot randomized controlled trial of mindfulness-based stress reduction for caregivers of family members with dementia. Aging Ment Health. 2016;20:1157–66. doi: 10.1080/13607863.2015.1065790
6. Sihvonen AJ, Soimila S, Särkämö T. Post-stroke enriched auditory environment induces structural connectome plasticity: secondary analysis from a randomized controlled trial. Brain Imaging Behav. 2022;16(4):1813–22. doi: 10.1007/s11682-022-00661-6
7. Giacomello G, Scholten A, Parr MK. Current methods for stress marker detection in saliva. J Pharm Biomed Anal. 2020;191:113604. doi: 10.1016/j.jpba.2020.113604
8. Wong MM, Tahir T, Wong MM, Baron A, Finnerty R. Biomarkers of stress in music interventions: a systematic review. J Music Ther. 2021;58:241–77. doi: 10.1093/jmt/thab003
9. Kristenson M, Garvin P, Lundberg U. The role of saliva cortisol measurement in health and disease. Vol. 4. Potomac, MD: Bentham Books; 2011.
10. Theorell T. Regeneration and anabolism: the good perspective. In: Theorell T, ed. Handbook of socioeconomic determinants of occupational health, Springer Books, London 2020, pp. 1–13. Springer Link, Number 59093163-119715048. ISBN 9783030314378.
11. Lennartsson AK, Theorell T, Kushnir MM, Bergquist J, Jonsdottir IH. Perceived stress at work is associated with attenuated DHEA-S response during acute psychosocial stress. Psychoneuroendocrinology. 2013;38:1650–7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9301040/
12. Ouanes S, Clark C, Ricciardi J, Marechai B, Lewczuk P, Kornhuber J, et al. Cerebrospinal fluid cortisol and dehydroepiandrosterone sulfate, Alzheimer´s disease pathology and cognitive decline. Front Aging Neurosci. 2022. doi: 10.3389/fnagi.2022.892754
13. Baudin C, Lefèvre M, Selander J, Babisch W, Cadum E, Carlier MC, et al. Saliva cortisol in relation to aircraft noise exposure: pooled-analysis results from seven European countries. Environ Health. 2019;18:1–12. doi: 10.1186/s12940-019-0540-0
14. Pavlickova H, Russell, AE, Lightman S, McCabe R. Feasibility of salivary cortisol collection in patients and companions attending dementia diagnostic meetings in memory clinics. BMC Res Notes. 2021;14:1–6. doi: 10.1186/s13104-021-05446-6
15. Pu L, Todorovic M, Moyle, W, Jones C. Using salivary cortisol as an objective measure of physiological stress in people with dementia and chronic pain: a pilot feasibility study. Biol Res Nurs. 2020;22:520–6. doi: 10.1177/1099800420934543
16. Theorell T, Engström G, Hallinder H, Lennartsson AK, Kowalski J, Emami A. The use of saliva steroids (cortisol and DHEA-s) as biomarkers of changing stress levels in people with dementia and their caregivers: a pilot study. Sci Prog. 2021;104:1–18. doi: 10.1177/00368504211019856
17. Reisberg B, Ferris SH, de Leon MJ, Crook T. The Global Deterioration Scale for assessment of primary degenerative dementia. Am J Psychiatry. 1982;139:1136–9. doi: 10.1176/ajp.139.9.1136
18. Emami A, Hallinder H, Theorell T, Kim H, Engström G. The feasibility and acceptability of in-home saliva collection for stress in persons with dementia and their family caregivers. Biol Res Nurs. 2022;24:308–15. doi: 10.1177/10998004221076554
19. Kim H, Engström G, Theorell T, Hallinder H, Emami A. In-home online music-based intervention for stress, coping, and depression among family caregivers of persons with dementia: a pilot study. Geriatr Nurs. 2022;46:137–43. doi: 10.1016/j.gerinurse.2022.05.011
20. Willett WC, Howe GR, Kushi LH. Adjustment for total energy intake in epidemiologic studies. Am J Clin Nutr. 1997;65:1220S–8S; discussion 1229S–31S. doi: 10.1093/ajcn/65.4.1220S
21. Stalder T, Kirschbaum C, Kudielka BM, Adam EK, Pruessner JC, Wüst S, et al. Assessment of the cortisol awakening response: expert consensus guideline. Psychoneuroendocrinology. 2016;63:414–32. doi: 10.1016/j.psyneuen.2015.10.010
22. Persson R, Garde AH, Hansen ÅM, Österberg K, Larsson B, Örbaek P, et al. Seasonal variation in human salivary cortisol. Chronobiol Int. 2009;25:923–37. doi: 10.1080/07420520802553648
23. Popa LC, Manea MC, Velcea D, Șalapa I, Manea M, Ciobanu AM. Impact of Alzheimer’s dementia on caregivers and quality improvement through art and music therapy. Healthcare. 2021;9:698. doi: 10.3390/healthcare9060698
24. Chatterjee D, Hegde S, Thaut M. Neural plasticity: the substratum of music-based interventions in neurorehabilitation. NeuroRehabilitation. 2021;48:1–12. doi: 10.3233/NRE-208011
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