The National Institute of Aging has awarded two Emory University researchers a competitive $3.5 million RO1 grant aimed at discovering new ways to enhance cognitive empathy in the caregivers of individuals living with Alzheimer’s disease and other forms of dementia.

Professor of psychology James Rilling from Emory College of Arts and Sciences and Nell Hodgson Woodruff School of Nursing professor Ken Hepburn will lead the innovative study, titled “Effect of Cognitive Empathy Training on Dementia Caregivers.” Rilling will head the research project as principal investigator and project director, and Hepburn will serve as the multi-principal investigator.

Rilling, an expert in social cognitive neuroscience, and Hepburn, an expert in caregiving and aging, will lead a research team exploring the impact of cognitive empathy training — an intervention designed to help caregivers adopt the mental perspective of people living with dementia, enabling them to better understand and relate to, both cognitively and emotionally, what their loved ones are thinking and feeling.

The innovative approach is anticipated to improve the mental health and immune function of caregivers while simultaneously reducing inflammation levels, which are heightened by the stress of caregiving.

The highly interdisciplinary project will also involve School of Medicine professor Molly Perkins, co-director with Hepburn of the Emory Roybal Center for Dementia Caregiving Mastery, as well as researchers from the Rollins School of Public Health, including professor John Hanfelt and senior biostatistician Liping Zhao, both from the Department of Biostatistics and Bioinformatics and Emory’s Goizueta Alzheimer’s Disease Research Center. Thomas McDade, a professor in the Department of Anthropology at Northwestern University, is also part of the research team.

The research project will recruit family caregivers of persons living with dementia for a randomized controlled trial. Participants will be assigned either to receive cognitive empathy training or a control condition.

During the 10-day training period of the intervention, caregivers will take daily photographs of their loved ones and caption the photos to describe what they believe the PLWD is experiencing, thinking or feeling. The exercise is then repeated periodically over six months.

“This project employs a creative science approach to test the effect of an intuitive strategy for strengthening the emotional bond between two people that is being attenuated by a progressive dementia illness,” Hepburn says. “The photo-captioning process challenges caregivers to inhabit the thoughts, feelings and experiences of persons living with these illnesses. 

“Such acts of cognitive empathy may enhance caregivers’ daily care effectiveness and may also enable them to maintain emotional connection with persons whose illness is gradually eroding their capacity to connect with themselves, others and the world around them,” Hepburn says.

In 2023, an estimated 6.7 million Americans aged 65 and older were living with Alzheimer’s disease. The majority of these individuals are cared for at home by family members, who face considerable challenges in managing the complex emotional and physical needs of persons living with dementia.

The chronic stress of caregiving has been associated with negative mental health outcomes such as depression and anxiety, and even elevated levels of proinflammatory biomarkers, which are linked to a higher risk of age-related diseases.

The ultimate goal of the study is to understand how this cognitive empathy training intervention strengthens caregiver well-being at both the psychological and biological levels. Caregivers in the study will complete pre- and post-intervention assessments measuring perceived caregiver burden, depression, anxiety and relationship quality with their care recipient; they will also provide blood samples to assess inflammatory biomarkers and immune function.

In addition, the researchers will use fMRI (functional MRI) to investigate how cognitive empathy training influences caregivers' biological responses. The test will focus on areas associated with cognitive empathy while caregivers view photos of their loved ones and of others of the same gender, age and race.

The research could have wide-reaching implications for millions of family caregivers who often suffer in silence while supporting their loved ones through the difficult journey of dementia. If successful, cognitive empathy training could be a cost-effective, scalable intervention to improve the quality of life for both caregivers and care recipients alike.