MONDAY, Sept. 22, 2003 (HealthDayNews) -- Losing a loved one is always painful, but the knowledge that the person didn't suffer in the end can be some small comfort to family and friends.
So, the findings of a new study may offer solace to the bereaved.
In the September issue of Neuropsychopharmacology, researchers from the Netherlands report that levels of the stress hormone cortisol rise just before death as a result of the failure of bodily functions, not because of fear or pain.
"The levels of cortisol, our stress hormone, are strongly rising in the blood and cerebrospinal fluid in the last phase of our life," says study author Dr. Dick Swaab, director of Neurobiology at the Netherlands Institute for Brain Research in Amsterdam.
Cortisol, Swaab explains, protects the body and the brain in stressful circumstances and it helps to make energy available for the body to react to danger or stress.
Swaab says the question researchers wanted to answer was why these levels rise. They particularly wanted to know if psychological fear or physical suffering were responsible for the jump in cortisol levels.
To answer this question, Swaab and his colleagues compared cortisol levels from 85 Alzheimer's patients to levels in 52 other people without dementia after their death. The researchers also looked at cortisol levels in 19 control patients and 54 Alzheimer's patients who were given high-dose painkilling treatment with morphine during the last two weeks of their lives.
"In individuals who are not conscious of the fact that they are going to die because they are demented or because they are exposed to high doses of morphine, the same strong rise in cortisol levels was found," explains Swaab.
In fact, cortisol levels were consistently higher in the people with Alzheimer's. In the control group, those treated with morphine had slightly lower levels of cortisol, but the Alzheimer's patients who were given morphine had higher levels of cortisol than those who didn't receive morphine.
That means, he says, that the psychological stress or the fear of dying isn't the cause of the cortisol rise because the Alzheimer's patients didn't know they were going to die. It also means that physical pain isn't the cause of the cortisol rise either, because patients on high doses of morphine still had high increases in their levels of cortisol.
Swaab says the higher levels of cortisol may simply be a protective physiological response that occurs as different body functions start to fail.
"This study shows that patients don't necessarily recognize the stress of dying. It's more physiological than psychological," says Dr. Annette Carron, director of palliative care services at William Beaumont Hospital in Royal Oak, Mich. "It's nice for families to think that they're not suffering."
More information
This article from the Medical College of Wisconsin discusses the benefits of end of life care. To learn more about Alzheimer's disease, go to the Alzheimer's Disease Education and Referral Center.
