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Tackling Alzheimer's, Depression

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Counseling along with support services may reduce the risk of depression in people caring for a spouse with Alzheimer's disease, a new study says.

The study also suggests that giving support might help people who are not clinically depressed but who endure the chronic stress of caring for someone with the progressive brain disease. Other research suggests that chronic stress might damage the immune system and put caregivers at risk for diseases such as cancer.

The study began with the experiences of two elderly counselors who had started providing informal help to spouses in the hallways of New York University's Alzheimer's Unit.

''We noticed that caregivers often looked very upset and bewildered,'' says NYU counselor Emma Shulman, who at 91 has plenty of life experiences as well as a degree in social work to help provide guidance to others. Shulman and her colleague, 84-year-old Gertrude Steinberg, began to offer advice to spouses who were caring for a partner with Alzheimer's disease.

Those hallway counseling sessions seemed to help, but epidemiologist Mary Mittelman and her colleagues wanted to size up the benefit in a scientific study.

The team recruited 406 people who cared for a spouse with Alzheimer's disease at home. Half were assigned to a usual support group and typically did not get formal counseling. The other half received the intensive counseling services: Shulman, Steinberg or one of the other geriatric specialists at NYU sat down with the spouse of an Alzheimer patient to size up their situation and recommend services that might provide some relief.

That first counseling session was followed by another individual session and four family meetings. Social workers might recommend and line up respite care to give the caregiver a break, or they might help a spouse work through the complicated financial problems that crop up when a partner can no longer pay the bills or balance the checkbook.

The researchers gave the caregivers a test that measured symptoms of depression at the study's start and at intervals throughout the five-year study. They found that after one year, slightly less than 30% of people in the group that received the extra help had signs of depression, compared with 45% of the other spouses.

The extra-help group had fewer symptoms of depression altogether. The positive effect lasted for more than three years after the initial counseling sessions.

That benefit persisted even after a spouse died or had to enter a nursing home, according to the study published in the May 1 issue of the American Journal of Psychiatry.

The NYU staff got calls every day from spouses dealing with problems that ranged from the physical demands of caregiving to financial problems such as how to pay for home health care, a service typically not covered by Medicare.

Counselors also can help caregivers minimize the behavioral difficulties caused by the disease. People with Alzheimer's can become aggressive and lash out at a family member. ''This is a very difficult disease to live with,'' Mittelman says.

Alzheimer's disease can affect the entire family, but spouses can suffer the most, says Sidney Stahl, an Alzheimer's expert at the National Institute on Aging, which helped fund the study. He urges caregivers to seek help not just with day-to-day problems, but also with the emotional difficulty of watching the disease destroy their partner's mind.

''They're literally not the same person,'' Stahl says. ''That's got to be heartbreaking for the caregiver.''Tips for caregivers:

* Learn all you can about the disease and caregiving techniques.

* Get help from family members, friends and community services.

* Manage stress with relaxation techniques and time off.

* Get an annual physical and take care of yourself.

* Don't feel guilty if you can't do it all.

For help, call the Alzheimer's Association at 800-272-3900.

Source: The Alzheimer's Association

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