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Does Pharmacological Treatment of Neuropsychiatric Symptoms in Alzheimer’s Disease Relieve Caregiver Burden?

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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.

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Acknowledgements

This study was not funded by any organization or company. Dr Lanctôt has received research funding, consultation fees, and/or speakers’ honoraria from Abbott Laboratories, Lundbeck, Pfizer, Janssen-Ortho Inc., and Wyeth. Dr Herrmann has received research funding, consultation fees, and/or speakers’ honoraria from Lundbeck, Pfizer, Janssen-Ortho Inc., Novartis and Sonexa. Ms Li has received travel honoraria from Abbott Laboratories. Ms Levy and Mr Farber have no financial relationships to disclose.

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  1. Sunnybrook Health Sciences Centre, Neuropsychopharmacology Research Group, 2075 Bayview Avenue, Suite FG05, Toronto, Ontario, Canada, M4N 3M5

    Karen Levy,  Krista L. Lanctôt Ph.D., Shale B. Farber, Abby Li & Nathan Herrmann

  2. Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Krista L. Lanctôt Ph.D. & Nathan Herrmann

  3. Department of Pharmacology, University of Toronto, Toronto, ON, Canada

    Krista L. Lanctôt Ph.D.

  4. Department of Psychiatry, University of Toronto, Toronto, ON, Canada

    Krista L. Lanctôt Ph.D. & Nathan Herrmann

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  1. Karen Levy
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Correspondence to Krista L. Lanctôt Ph.D..

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Levy, K., Lanctôt, K.L., Farber, S.B. et al. Does Pharmacological Treatment of Neuropsychiatric Symptoms in Alzheimer’s Disease Relieve Caregiver Burden?. Drugs Aging 29, 167–179 (2012). https://doi.org/10.2165/11599140-000000000-00000

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