The Neurobiology of Adult Caregiving Open Access

Zhang, Jiajin (Spring 2022)

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Background: There are more than 16 million family caregivers for dementia patients in the U.S. Caring for demented family members is highly stressful, causing various negative impacts on caregivers’ mental and physical health. While the well-being of caregivers has become an important research topic, little is known about the neural substrate that underlies adult caregiving. This is the first study on the neurobiology of adult caregiving.

Method: We recruited 20 high-burden caregivers of dementia patients and imaged their brain function with fMRI while they viewed photos of their patient, a friend of similar age and same-sex, and an unknown patient of matching sex, age, and race.  Caregivers also completed questionnaires to determine if their mental health status modulated their neural response to their patients. Neural activity in caregivers was also compared with neural activity in a sample of grandmothers.

Results: Compared to unknown adults, patients' photos activated brain regions involved in core aspects of parental caregiving, including emotional empathy (dorsal anterior cingulate, anterior insula and inferior frontal gyrus), cognitive empathy (dorsomedial prefrontal cortex and temporo-parietal junction) and reward and motivation (substantia nigra/VTA, nucleus accumbens, and caudate nucleus). After controlling for the familiarity of stimuli, viewing patients' photos activated brain regions involved with emotional empathy, as well as reward and motivation. Perceived stress and depressive symptomatology were positively correlated with neural activity in the lateral orbitofrontal cortex, a region implicated in depression and emotional regulation for negative stimuli, as well as regions involved in reward, emotional and cognitive empathy. Grandmothers more strongly activated reward and motivation regions when viewing photos of their grandchildren, whereas caregivers more strongly activated precuneus when viewing photos of their patients.

Conclusion: Our study shows that adult caregiving shares the parental caregiving neural network. Higher levels of depression, perceived stress, and burden were associated with stronger activation in lateral OFC as well as regions involved in reward, emotional and cognitive empathy. Caregiving neural activity may vary depending on the age of the care recipient. With further validation, the results of our study could be used to assess the efficacy of interventions for caregiver mental health on a neural level. 

Table of Contents

Introduction 5

Materials and Methods 12

Results 16

Discussion 27

Future Directions 34

Supplemental Materials  37

References 39

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