title: Neuropsychiatric symptoms in Alzheimer's disease: associations with caregiver burden and treatment outcomes.
abstract: BACKGROUND
  Caregivers play a major role in providing care for patients with Alzheimer's disease (AD) and are themselves at higher risk of health comorbidities.
  
  
  OBJECTIVE
  To address the impact of neuropsychiatric symptoms of patients in different stages of AD on their caregivers' burden.
  
  
  METHODS
  This prospective study enrolled 260 AD patients with clinical dementia rating (CDR) of 0.5, 1 and 2 at a tertiary medical center.
  
  
  METHODS
  All patients were tested using the mini-mental state examination (MMSE), the cognitive abilities screening instrument (CASI), the neuropsychiatric inventory (NPI) and the CDR scale. Data regarding therapeutic outcomes of anti-Alzheimer's drugs were also collected. Caregivers were tested using NPI.
  
  
  RESULTS
  The mean follow-up interval was 25.0 ± 12.2 months, and two patients died during follow-up. NPI-burden was positively correlated with NPI-sum ( r  = 0.822, P  <   0.001) but negatively correlated with years of education ( r  = -0.140, P  =   0.024), CASI score ( r  = -0.259, P  <   0.001) and MMSE score ( r  = -0.262, P  <0.001). Multiple linear regression analysis showed that only NPI-sum was independently associated with mean NPI-burden. Both higher mean CASI and MMSE scores had better therapeutic outcome of anti-Alzheimer's drugs ( P  =   0.001 and P =   0.005, respectively).
  
  
  CONCLUSIONS
  The severity of neuropsychiatric symptoms in patients with AD was positively associated with caregiver's stress, and patients with better cognitive functions, under treatment with anti-Alzheimer's drugs, had better therapeutic outcomes. To reduce the impact of neuropsychiatric symptoms, it is crucial to detect dementia in its early phases and provide early intervention with anti-Alzheimer's drugs, which might help decrease the caregiver burden, thereby improving their quality of life.
authors.affiliation: Department of Family Medicine.
authors.forename: C T
authors.initials: CT
authors.lastname: Chen
authors.affiliation: Department of Neurology.
authors.forename: C-C
authors.initials: CC
authors.lastname: Chang
authors.affiliation: Department of Neurology.
authors.forename: W-N
authors.initials: WN
authors.lastname: Chang
authors.affiliation: Department of Neurology.
authors.forename: N-W
authors.initials: NW
authors.lastname: Tsai
authors.affiliation: Department of Neurology.
authors.forename: C-C
authors.initials: CC
authors.lastname: Huang
authors.affiliation: Department of Neurology.
authors.forename: Y-T
authors.initials: YT
authors.lastname: Chang
authors.affiliation: Department of Neurosurgery.
authors.forename: H-C
authors.initials: HC
authors.lastname: Wang
authors.affiliation: Department of Emergency Medicine.
authors.forename: C-T
authors.initials: CT
authors.lastname: Kung
authors.affiliation: Department of Internal Medicine.
authors.forename: Y-J
authors.initials: YJ
authors.lastname: Su
authors.affiliation: Department of Radiology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
authors.forename: W-C
authors.initials: WC
authors.lastname: Lin
authors.affiliation: Department of Internal Medicine.|Department of Biological Science, National Sun Yat-Sen University, Kaohsiung 833, Taiwan.
authors.forename: B-C
authors.initials: BC
authors.lastname: Cheng
authors.affiliation: Department of Emergency Medicine.
authors.forename: C-M
authors.initials: CM
authors.lastname: Su
authors.affiliation: Department of Emergency Medicine.|Department of Biological Science, National Sun Yat-Sen University, Kaohsiung 833, Taiwan.
authors.forename: S-Y
authors.initials: SY
authors.lastname: Hsiao
authors.affiliation: Department of Neurology.|Department of Biological Science, National Sun Yat-Sen University, Kaohsiung 833, Taiwan.
authors.forename: C-W
authors.initials: CW
authors.lastname: Hsu
authors.affiliation: Department of Neurology.|Department of Biological Science, National Sun Yat-Sen University, Kaohsiung 833, Taiwan.|Department of Neurology, Xiamen Chang Gung Memorial Hospital, Xiamen, China.
authors.forename: C-H
authors.initials: CH
authors.lastname: Lu
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D001526:Behavioral Symptoms / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D017028:Caregivers / Q000523:psychology*; D002681:China; D003071:Cognition; D017281:Cost of Illness; D005260:Female; D006801:Humans; D008297:Male; D016743:Mental Competency / Q000523:psychology; D008875:Middle Aged; D009483:Neuropsychological Tests; D018697:Nootropic Agents / Q000627:therapeutic use*; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D016896:Treatment Outcome
chemical_list: D018697:Nootropic Agents