title: Effect of second-generation antipsychotics on caregiver burden in Alzheimer's disease.
abstract: BACKGROUND
  Alzheimer's disease (AD) imposes a severe burden upon patients and their caregivers. Severity of psychiatric symptoms and behavioral disturbances is an important determinant of caregivers' experience of burden. These symptoms may be improved with atypical antipsychotic treatment.
  
  
  OBJECTIVE
  Data from the Clinical Antipsychotic Trials of Intervention Effectiveness-Alzheimer's Disease (CATIE-AD) trial were used to evaluate the effect of atypical antipsychotics versus placebo on the experiences of caregivers of outpatients with AD.
  
  
  METHODS
  We compared the effect of atypical antipsychotic drugs (olanzapine, risperidone, or quetiapine-considered together as a group) versus placebo on the experiences of caregivers of AD outpatients (diagnosed according to DSM-IV-TR). We also evaluated whether improvement in patients' psychiatric and behavioral symptoms mediated the relationship between drug treatment and caregiver burden. The CATIE-AD trial, conducted from April 2001 through November 2004, included outpatients (mean age = 77.9 years [SD = 7.5 years]) in usual care settings and assessed treatment effectiveness over a 9-month period at 42 US sites. In a set of secondary analyses, data from CATIE-AD participants who had at least 1 postbaseline outcome assessment and data from their caregivers were examined in an intention-to-treat (ITT) analysis (N = 361). A phase 1-only analysis was conducted including only observations while patients were receiving the initially randomized drug (N = 153). The Burden Interview, the Beck Depression Inventory, and the Neuropsychiatric Inventory (NPI) Caregiver Distress Scale were used to evaluate caregiver burden.
  
  
  RESULTS
  In both ITT and phase 1-only analyses, caregivers of patients treated with second-generation antipsychotics scored significantly lower than caregivers of patients receiving placebo on both the Burden Interview (P = .0090) and the NPI Caregiver Distress Scale (P = .0209). These differences appeared to have been mediated by lower levels of agitation, hostility, and psychotic distortions.
  
  
  CONCLUSIONS
  In AD patients with symptoms of psychosis, agitation, or aggressive behavior, medications can have a small but significant impact on caregiver burden.
authors.affiliation: Veterans Affairs New England Mental Illness Research, Education and Clinical Center, West Haven, CT, USA. Somaia.Mohamed@yale.edu
authors.forename: Somaia
authors.initials: S
authors.lastname: Mohamed
authors.forename: Robert
authors.initials: R
authors.lastname: Rosenheck
authors.forename: Constantine G
authors.initials: CG
authors.lastname: Lyketsos
authors.forename: Richard
authors.initials: R
authors.lastname: Kaczynski
authors.forename: David L
authors.initials: DL
authors.lastname: Sultzer
authors.forename: Lon S
authors.initials: LS
authors.lastname: Schneider
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000368:Aged; D000544:Alzheimer Disease / Q000150:complications / Q000188:drug therapy* / Q000451:nursing* / Q000523:psychology; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D017028:Caregivers / Q000523:psychology*; D017281:Cost of Illness; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000188:drug therapy* / Q000523:psychology*; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011788:Quality of Life / Q000523:psychology
chemical_list: D014150:Antipsychotic Agents