ABSTRACT The goal of the parent project is to understand which AD spousal caregivers are most vulnerable to the deleterious physical health effects of spousal dementia caregiving as they navigate the experience of living bereavement, while coping with the burden of caregiving and trying to maintain QOL. As an exploratory aim, we will examine how these individual in attachment orientation affect both members of the marital relationship dyadically. Three hundred and twenty AD spousal caregivers will complete assessments of attachment, QOL, caregiver burden, grief symptoms, and participate in a blood draw to evaluate inflammation and GCR, and HF- HRV four times over a two-year period. They will also participate in a brief interview in reference to the AD spouse's QOL and attachment orientation. The AD patient with mild to moderate AD will also answer questions used previously among AD patients to assess attachment and QOL. The present study aims to characterize the association between Alzheimer's Disease spousal caregivers' experience of affiliate stigma, which refers to the internationalization of negative public views toward oneself, anxiety and depression and parasympathetic activity, as indexed by heart rate variability. Previous research suggests that caregivers are subject to experiencing stigma that contributes to chronic stress, and consequently, autonomic imbalance, which is predictive of cardiovascular disease. Yet, to our knowledge, no study exists that considers how the adverse effects of affiliate stigma influence parasympathetic activity among AD spousal caregivers. We anticipate that AD spousal caregivers who experience higher affiliate stigma will associate with increased levels of anxiety and depression and decreased levels of HRV. We must seek to understand these interactions better, so we may determine which AD spousal caregivers are most disposed to the adverse health effects of affiliate stigma and provide targeted treatments to alleviate the intense stress of AD caregiving.