title: Does pharmacological treatment of neuropsychiatric symptoms in Alzheimer's disease relieve caregiver burden?
abstract: Caregiving for patients with Alzheimer's disease (AD) is associated with negative outcomes for the caregiver such as depression, anxiety, medical illness, poorer general health and mortality, which further translate into adverse outcomes for the patient. The burden experienced by caregivers of AD patients, both professional and informal, has been found to be positively related to the presence and severity of the patients' neuropsychiatric symptoms, also referred to as the behavioural and psychological symptoms of dementia (BPSD). As such, management of BPSD may help in alleviating caregiver burden. The purpose of this review is to summarize the current literature on the effects of pharmacological interventions for BPSD on the burden of AD patient caregivers. A literature review was conducted, using keywords related to dementia, drug treatment, caregiving and BPSD. Studies were included if they were a randomized controlled trial of a currently marketed drug in AD patients, and included a measure of caregiver burden and BPSD. Twenty-four articles met the eligibility criteria for this review. Cognitive enhancers (cholinesterase inhibitors, memantine) were associated with decreased caregiver burden in some studies, though it is unclear whether the improvements were related to changes in BPSD or cognition and function. Antipsychotics have been associated with decreased caregiver burden in some studies, though variability may be related to disease severity. Other drug treatments, including antidepressants, have also been shown to have inconsistent effects on caregiver burden. Besides the small number of clinical trials that included a measure of caregiver burden, there is large variability in the literature due to differing conceptualizations of caregiver burden and the lack of a recognized gold standard for caregiving burden assessment. It is therefore difficult to draw strong conclusions about whether the pharmacological management of BPSD relieves caregiver burden. Given the importance of caregiver burden and its negative consequences for the caregiver and the patient, future clinical trials should pay more attention to this crucial outcome.
authors.affiliation: Sunnybrook Health Sciences Centre, Neuropsychopharmacology Research Group, 2075 Bayview Avenue, Suite FG05, Toronto, Ontario, Canada, M4N 3M5.
authors.forename: Karen
authors.initials: K
authors.lastname: Levy
authors.affiliation: Sunnybrook Health Sciences Centre, Neuropsychopharmacology Research Group, 2075 Bayview Avenue, Suite FG05, Toronto, Ontario, Canada, M4N 3M5. krista.lanctot@sunnybrook.ca.|Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. krista.lanctot@sunnybrook.ca.|Department of Pharmacology, University of Toronto, Toronto, ON, Canada. krista.lanctot@sunnybrook.ca.|Department of Psychiatry, University of Toronto, Toronto, ON, Canada. krista.lanctot@sunnybrook.ca.
authors.forename: Krista L
authors.initials: KL
authors.lastname: Lanctôt
authors.affiliation: Sunnybrook Health Sciences Centre, Neuropsychopharmacology Research Group, 2075 Bayview Avenue, Suite FG05, Toronto, Ontario, Canada, M4N 3M5.
authors.forename: Shale B
authors.initials: SB
authors.lastname: Farber
authors.affiliation: Sunnybrook Health Sciences Centre, Neuropsychopharmacology Research Group, 2075 Bayview Avenue, Suite FG05, Toronto, Ontario, Canada, M4N 3M5.
authors.forename: Abby
authors.initials: A
authors.lastname: Li
authors.affiliation: Sunnybrook Health Sciences Centre, Neuropsychopharmacology Research Group, 2075 Bayview Avenue, Suite FG05, Toronto, Ontario, Canada, M4N 3M5.|Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.|Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
authors.forename: Nathan
authors.initials: N
authors.lastname: Herrmann
mesh_terms: D000544:Alzheimer Disease / Q000188:drug therapy* / Q000523:psychology*; D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D017028:Caregivers / Q000523:psychology; D017281:Cost of Illness; D006801:Humans; D018697:Nootropic Agents / Q000627:therapeutic use; D011788:Quality of Life; D013312:Stress, Physiological; D013315:Stress, Psychological / Q000517:prevention & control
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D018697:Nootropic Agents