Imagine you’re planning a fun day out with your friends. You have two options: spend the whole day at an overcrowded, noisy theme park or opt for a peaceful visit to a local museum. For people living with dementia and their caregivers, choosing the right treatment option can be just as important. In this study, researchers wanted to see if day clinic treatment could be a suitable alternative to hospitalization for people living with dementia. They also explored the use of psychobiological stress measures, like hair cortisol concentrations and salivary cortisol, to assess treatment success. And guess what? The results were promising! While questionnaires and hair cortisol assessments were more practical, they found that these measures didn’t always align with how patients reported their stress levels. Interestingly, children caring for their parents with dementia seemed to benefit the most from day clinic treatment. By taking advantage of physiological stress markers, we can gain valuable insights into how treatments impact both individuals with dementia and their caregivers. If you want to dive deeper into this fascinating research, check out the full article!

BackgroundHospitalization is often stressful and burdensome for people living with dementia (PwD) and their informal caregivers (ICs). Day clinic treatment may provide a suitable alternative, but is often precluded by a diagnosis of dementia. Furthermore, it is often caregiver-based ratings that measure treatment success as the validity of self-reports in PwD is critically discussed. We therefore set out to examine the feasibility of psychobiological stress measures in PwD and ICs and to evaluate treatment trajectories considering both the day clinic context and the daily life of the dyads.MethodA total of 40 dyads of PwD (mean age: 78.15 ± 6.80) and their ICs (mean age: 63.85 ± 13.09) completed paper-and-pencil questionnaires (covering stress, depressive symptoms, and caregiver burden among others) in addition to the measurement of hair cortisol concentrations (HCC) at admission, discharge, and follow-up 6 months after day clinic treatment. As part of an ambulatory assessment, for 2 days at the beginning and 2 days at the end of the day clinic treatment, PwD and ICs collected six saliva samples per day for the analysis of salivary cortisol (sCort) and alpha-amylase (sAA).ResultsPaper-and-pencil questionnaires and HCC assessments were more feasible than the ambulatory assessment. We found discrepancies between subjective and physiological markers of stress in PwD. Whereas HCC decreased over time, self-reported stress increased. Child–parent dyads reported decreases in neuropsychiatric symptoms, associated burden, and self-reported stress from admission to follow-up. In daily life, both PwD and ICs showed characteristic diurnal profiles of sAA and sCort, however, we found no differences in summary indicators of salivary stress markers over time.DiscussionThe psychobiological evaluation was feasible and added informative value, underlining the potential of physiological stress markers to complement self-reports on stress in PwD and to objectively evaluate treatment trajectories. In this sample, HCC was more feasible and acceptable as biological marker of stress compared to saliva samples. Concerning treatment trajectories, differential effects on the dyads were found, with child–parent dyads benefiting more from day clinic treatment compared to spousal dyads.

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