Alzheimer’s is a debilitating disease for its victims — but it can also take a toll on a patient’s caregiver.

Led by epidemiology professor Joan Monin, researchers at the Yale School of Public Health have conducted a study evaluating the ways in which Alzheimer’s patients and their caregivers maintain stable and trusting relationships.

Caregivers are typically spouses or other family members who provide day-to-day support to Alzheimer’s patients including feeding and entertaining them. The study, published in the October issue of the Aging & Mental Health journal, found that inconsistent or detached caregiving can cause Alzheimer’s patients to lose trust in their loved ones, exacerbating physical symptoms of the disease.

“Physicians have to look out for the emotional environment their patient is in,” Monin said. “That’s why it’s important to provide support to family members of people with Alzheimer’s.”

Because many Alzheimer’s patients are not able to communicate their emotions effectively, Monin’s research team worked with patients of fairly advanced cognitive functioning. Researchers surveyed and interviewed the patients and caregivers at various stages of the disease treatment, asking each to report on levels of trust they felt toward one another.

“Imagine how it feels to be married to someone who is slowly forgetting who you are,” Monin said. “The relationships between spousal caregivers and patients have the potential for emotional stress.”

Monin’s team found that relationships lacking in trust could be classified as either “attachment anxiety” or “attachment avoidance” relationships. Attachment anxiety is a relationship characterized by insecurity and lack of trust, and attachment avoidance is a relationship in which the caregiver intentionally distances himself from the patient emotionally. Both exacerbate the physical symptoms of Alzheimer’s, which can include impaired speech and language skills, compromised motor skills and loss of bladder control, according to the National Alzheimer’s Association.

Morin is one of the first researchers to evaluate caregiver-patient relationships. Because her field of research is relatively new, Morin said her findings could have significant implications for physicians treating Alzheimer’s, potentially leading to interventions such as couples’ therapy for the patient and caregiver.

“Evaluating an Alzheimer’s patient’s emotional responses is not something traditional pharmaceutical companies were ever interested in,” said Geoffrey Kerchner, a behavioral neurologist at Stanford who treats Alzheimer’s patients.

Though Morin is one of the first scientists to evaluate caregiver-patient relationships, the practice of treating caregivers’ health was established several decades ago. Maria Tomasetti, south central regional director of the National Alzheimer’s Association, said that in the past 20 years, researchers and medical service providers have increasingly realized that improving caregivers’ emotional health benefits the physical health of patients with Alzheimer’s.

“People who are caring for someone with dementia tend to think they can do it all on their own,” Tomasetti said. “But caregiving is a long and unpredictable process. Sometimes the caregiver can actually become physically sick, and that takes a toll on the Alzheimer’s patient.”

Monin is continuing her research on caregiver health and is currently focused on understanding how a patient’s suffering impacts the psychological health of their family members.

As many as 5.1 million Americans may have Alzheimer’s disease, according to the National Institute on Aging.