Effect of Cognitive Empathy Training on Dementia Caregivers

Project Summary An estimated 5.8 million Americans age 65 and older are living with Alzheimer’s dementia in 2020. The majority of these individuals are cared for at home by family members. Caring for people living with dementia (PLWD) can be very stressful, and is associated with negative mental health outcomes, including depression

and anxiety. The chronic stress of caregiving has also been associated with increased levels of proinflammatory biomarkers, which mediate many of the chronic diseases of aging. High levels of cognitive empathy have been associated with lower levels of subjective stress and depression among dementia caregivers. Cognitive empathy is the ability to adopt another individual’s mental perspective and to understand

what they are thinking or feeling and why. The goal of this project is to investigate the effect of cognitive empathy training on mental health, inflammation and immune function in caregivers of PLWD, and to examine the underlying psychological and neurobiological mechanisms. Our first aim is to establish the effectiveness of

cognitive empathy training in improving caregiver mental health and immune function, and in decreasing caregiver inflammation. In a cross-over design, caregivers will be randomized to either cognitive empathy training or a control condition. Prior to the training, caregivers will complete questionnaires on perceived

caregiver burden, depression and anxiety. A bloodspot sample will be collected to assay levels of pro- inflammatory cytokines (IL-6, IL-10, TNF-α and CRP), and Epstein-Barr virus antibody titers as a marker of cellular immune function. The training involves caregivers taking 3-5 daily photos of their PLWD with their

smartphone over a 10-day period. After taking each photo, caregivers caption it with text that describes what the caregiver believes the PLWD is thinking, feeling or experiencing in that moment. The exercise is subsequently repeated for a single day, at two-week intervals for six months. Immediately after the 10-day

training, and again at 6 months post-training, caregivers will again complete the questionnaires and provide bloodspot samples. Changes from the pre-training baseline will be calculated. Our second aim is to investigate the psychological and neurobiological mechanism by which cognitive empathy training improves caregiver

well-being, inflammation and immune function. Caregiver cognitive and emotional empathy, as well as dyadic relationship quality, will be quantified with self-report questionnaires both pre- and post-training. In addition, brain function will be measured with fMRI as caregivers view photos of their PLWD and attempt to empathize

with them. Finally, caregivers will also be interviewed for a qualitative assessment of the impact of the training on relationship and caregiving quality. We hypothesize that the training will increase activation in brain regions involved with cognitive empathy along with self-reported cognitive empathy, and improve caregiver/recipient

relationship quality, immune function and mental health, while at the same time decreasing inflammation.