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Reduction of Caregiver Burden in Alzheimer's Disease by Treatment with Galantamine

Published online by Cambridge University Press:  07 November 2014


Alzheimer's disease is a progressive condition characterized by a loss of cognition, altered behavior, and a loss of functional ability, such as bathing, dressing, toileting, and organizing finances. Family and friends provide nearly three quarters of all care for patients with Alzheimer's disease. This informal care results in significant burden to caregivers. Caregiver burden is the set of physical, psychological or emotional, social, and financial problems that family members may experience when caring for impaired older adults. Caregivers of Alzheimer's disease patients report higher rates of physical symptoms, mortality, depression, and fatigue, as well as adverse effects on employment compared with those who are not caregivers for Alzheimer's disease patients. In many cases, the same family members are responsible for both out-of-pocket expenditures and caregiving duties. For this article, a MEDLINE search using the key words “caregiver and Alzheimer's disease” and “cost and Alzheimer's disease” was performed. The purpose of this article is to review the literature on caregiver burden, the components of caregiver burden, effects of caregiving on the health of caregivers, the cost of Alzheimer's disease on the caregiver and society, and the benefits attainable with treatment.

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1. Hebert, LE, Scherr, PA, Bienias, JL, Bennett, DA, Evans, DA. Alzheimer disease in the US population: prevalence estimates using the 2000 census. Arch Neurol. 2003;60:11191122.CrossRefGoogle ScholarPubMed
2. Meek, PD, McKeithan, K, Schumock, GT. Economic considerations in Alzheimer's disease. Pharmacotherapy. 1998;18(2 pt 2):6873.Google ScholarPubMed
3. Small, GW, McDonnellv, DD, Brooks, RL, Papadopoulos, G. The impact of symptom severity on the cost of Alzheimer's disease. J Am Geriatr Soc. 2002;50:321327.CrossRefGoogle Scholar
4. Max, W, Webber, P, Fox, P. Alzheimer's disease. The unpaid burden of caring. J Aging Health. 1995;7:179199.CrossRefGoogle ScholarPubMed
5. Rice, DP, Fox, PJ, Max, W, et al. The economic burden of Alzheimer's disease care. Health Aff (Millwood). 1993;12:164176.CrossRefGoogle ScholarPubMed
6. Stommel, M, Collins, CE, Given, BA. The costs of family contributions to the care of persons with dementia. Gerontologist. 1994;34:199205.CrossRefGoogle ScholarPubMed
7. George, LK, Gwyther, LP. Caregiver well-being: a multidimensional examination of family caregivers of demented adults. Gerontologist. 1986;26:253259.CrossRefGoogle ScholarPubMed
8. Rabins, PV, Mace, MA, Lucas, MJ. The impact of dementia on the family. JAMA. 1982;248:333335.CrossRefGoogle Scholar
9. Poulshock, SW, Deimling, GT. Families caring for elders in residence: issues in the measurement of burden. J Gerontol. 1984;39:230239.CrossRefGoogle ScholarPubMed
10. Ham, R. Evolving standards in patient and caregiver support. Alzheimer Dis Assoc Disord. 1999;13(suppl 2):S27S35.Google ScholarPubMed
11. Mohide, EA. Informal care of community-dwelling patients with Alzheimer's disease: focus on the family caregiver. Neurology. 1993;43(suppl 4):S16S19.Google Scholar
12. Donaldson, C, Tarrier, N, Burns, A. Determinants of carer stress in Alzheimer's disease. Int J Geriatr Psychiatry. 1998;13:248256.3.0.CO;2-0>CrossRefGoogle ScholarPubMed
13. Nagaratnam, N, Lewis-Jones, M, Scott, D, Palazzi, L. Behavioral and psychiatric manifestations in dementia patients in a community: caregiver burden and outcome. Alzheimer Dis Assoc Disord. 1998;12:330334.CrossRefGoogle Scholar
14. Kaufer, DI, Cummings, JL, Christine, D, et al. Assessing the impact of neuropsychiatric symptoms in Alzheimer's disease: the Neuropsychiatric Inventory Caregiver Distress Scale. J Am Geriatr Soc. 1998;46:210215.CrossRefGoogle Scholar
15. Haley, WE. The family caregiver's role in Alzheimer's disease. Neurology. 1997;48(5 Suppl 6):S25S29.CrossRefGoogle ScholarPubMed
16. Shaw, WS, Patterson, TL, Ziegler, MG, et al. Accelerated risk of hypertensive blood pressure recordings among Alzheimer caregivers. J Psychosom Res. 1999;46:215227.CrossRefGoogle ScholarPubMed
17. Schulz, R, Beach, SR. Caregiving as a risk factor for mortality: the Caregiver Health Effects Study. JAMA. 1999;282:22152219.CrossRefGoogle ScholarPubMed
18. Radloff, LS, Teri, L. Use of the Center for Epidemiological Studies-Depression Scale with older adults. Clin Gerontol. 1986;5:119136.CrossRefGoogle Scholar
19. Aday, LA. Health Care in the United States. Beverly Hills, Calif: Sage Publications; 1980.Google Scholar
20. Baumgarten, M, Battista, RN, Infante-Rivard, C, et al. The psychological and physical health of family members caring for an elderly person with dementia. J Clin Epidemiol. 1992;45:6170.CrossRefGoogle ScholarPubMed
21. Teri, L. Behavior and caregiver burden: behavioral problems in patients with Alzheimer disease and its association with caregiver distress. Alzheimer Dis Assoc Disord. 1997;11(suppl 4):S35S38.Google ScholarPubMed
22. Clipp, EC, Moore, MJ. Caregiver time use: an outcome measure in clinical trial research on Alzheimer's disease. Clin Pharmacol Ther. 1995;58:228236.CrossRefGoogle ScholarPubMed
23. Caro, J, Ward, A, Ishak, K, et al. To what degree does cognitive impairment in Alzheimer's disease predict dependence of patients on caregivers? BMC Neurol. 2002;2:6.CrossRefGoogle ScholarPubMed
24. Chokroverty, S. Sleep disorders in elderly persons. In: Chokroverty, S, ed. Sleep Disorders Medicine: Basic Science, Technical Considerations, and Clinical Aspects. 2nd ed. Boston, Mass: Butterworth-Heinemann; 1999:401415.Google Scholar
25. Bliwise, DL, Tinklenberg, JR, Yesavage, JA. Timing of sleep and wakefulness in Alzheimer's disease patients residing at home. Biol Psychiatry. 1992;31:11631165.CrossRefGoogle ScholarPubMed
26. Moe, KE, Vitiello, MV, Larsen, LH, Prinz, PN. Symposium: Cognitive processes and sleep disturbances: sleep/wake patterns in Alzheimer's disease: relationships with cognition and function. J Sleep Res. 1995;4:1520.CrossRefGoogle ScholarPubMed
27. Reynolds, CF 3rd, Kupfer, DJ, Taska, LS, et al. EEG sleep in elderly depressed, demented, and healthy subjects. Biol Psychiatry. 1985;20:431442.CrossRefGoogle ScholarPubMed
28. Vitiello, MV, Borson, S. Sleep disturbances in patients with Alzheimer's disease: epidemiology, pathophysiology and treatment. CNS Drugs. 2001;15:777796.CrossRefGoogle ScholarPubMed
29. McCurry, SM, Logsdon, RG, Teri, L, et al. Characteristics of sleep disturbance in community-dwelling Alzheimer's disease patients. J Geriatr Psychiatry Neurol. 1999;12:5359.CrossRefGoogle ScholarPubMed
30. Buysse, DJ, Reynolds, CF, Monk, TH, Berman, SR, Kupfer, DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28:193213.CrossRefGoogle ScholarPubMed
31. Wilcox, S, King, AC. Sleep complaints in older women who are family caregivers. J Gerontol B Psychol Sci Soc Sci. 1999;54:P189P198.CrossRefGoogle ScholarPubMed
32. Ory, MG, Hoffman, RR 3rd, Yee, JL, Tennstedt, S, Schulz, R. Prevalence and impact of caregiving: a detailed comparison between dementia and nondementia caregivers. Gerontologist. 1999;39:177185.CrossRefGoogle ScholarPubMed
33. Scharlach, AE. A comparison of employed caregivers of cognitively impaired and physically impaired elderly persons. Res Aging. 1989;11:225243.CrossRefGoogle ScholarPubMed
34. McKinlay, JB, Crawford, SL, Tennstedt, SL. The everyday impacts of providing informal care to dependent elders and their consequences for the care recipients. J Aging Health. 1995;7:497528.CrossRefGoogle ScholarPubMed
35. Stone, RI, Short, PF. The competing demands of employment and informal caregiving to disabled elders. Med Care. 1990;28:513526.CrossRefGoogle ScholarPubMed
36. Stone, R, Cafferata, GL, Sangl, J. Caregivers of the frail elderly: a national profile. Gerontologist. 1987;27:616626.CrossRefGoogle ScholarPubMed
37. Markowitz, J, Gutterman, E, Papadopoulos, G, Sadik, K. Employment-related impact in caregivers of patients with Alzheimer's disease. Poster presented at: Annual meeting Alzheimer's Disease and Related Disorders; July 20-25, 2002; Stockholm, Sweden.Google Scholar
38. Ernst, RL, Hay, JW. The US economic and social costs of Alzheimer's disease revisited. Am J Public Health. 1994;84:12611264.CrossRefGoogle ScholarPubMed
39. Caro, JJ, Getsios, D, Migliaccio-Walle, K, Raggio, G, Ward, A; AHEAD Study Group. Assessment of health economics in Alzheimer's disease (AHEAD) based on need for full-time care. Neurology. 2001;57:964971.CrossRefGoogle Scholar
40. Langa, KM, Chernew, ME, Kabeto, MU, et al. National estimates of the quantity and cost of informal caregiving for the elderly with dementia. J Gen Intern Med. 2001;16:770778.CrossRefGoogle ScholarPubMed
41. Souetre, E, Thwaites, RM, Yeardley, HL. Economic impact of Alzheimer's disease in the United Kingdom. Cost of care and disease severity for non-institutionalised patients with Alzheimer's disease. Br J Psychiatry. 1999;174:5155.CrossRefGoogle Scholar
42. Stern, Y, Albert, M, Brandt, J, et al. Utility of extrapyramidal signs and psychosis as predictors of cognitive and functional decline, nursing home admission, and death in Alzheimer's disease: prospective analyses from the Predictors Study. Neurology. 1994;44:23002307.CrossRefGoogle ScholarPubMed
43. Wimo, A, Gustafsson, L, Mattson, B. Predictive validity of factors influencing the institutionalization of elderly people with psycho-geriatric disorders. Scand J Prim Health Care. 1992;10:185191.CrossRefGoogle ScholarPubMed
44. Colerick, EJ, George, LK. Predictors of institutionalization among caregivers of patients with Alzheimer's disease. J Am Geriatr Soc. 1986;34:493498.CrossRefGoogle ScholarPubMed
45. O'Donnell, BF, Drachman, DA, Barnes, HJ, et al. Incontinence and troublesome behaviors predict institutionalization in dementia. J Geriatr Psychiatry Neurol. 1992;5:4552.Google Scholar
46. Annerstedt, L, Elmstahl, S, Ingvad, B, Samuelsson, SM. Family caregiving in dementia—an analysis of the caregiver's burden and the “breaking-point” when home care becomes inadequate. Scand J Public Health. 2000;28:2331.CrossRefGoogle Scholar
47. Ernst, RL, Hay, JW, Fenn, C, Tinklenberg, J, Yesavage, JA. Cognitive function and the costs of Alzheimer disease. An exploratory study. Arch Neurol. 1997;54:687693.CrossRefGoogle ScholarPubMed
48. Raskind, MA, Peskind, ER, Wessel, T, Yuan, W. Galantamine in AD: A 6-month randomized, placebo-controlled trial with a 6-month extension. The Galantamine USA-1 Study Group. Neurology. 2000;54:22612268.CrossRefGoogle Scholar
49. Tariot, PN, Solomon, PR, Morris, JC, Kershaw, P, Lilienfeld, S, Ding, C. A 5-month, randomized, placebo-controlled trial of galantamine in AD. The Galantamine USA-10 Study Group. Neurology. 2000;54:22692276.CrossRefGoogle Scholar
50. Wilcock, GK, Lilienfeld, S, Gaens, E. Efficacy and safety of galantamine in patients with mild to moderate Alzheimer's disease: multicentre randomised controlled trial. Galantamine International-1 Study Group. BMJ. 2000;321:14451449.CrossRefGoogle Scholar
51. Rockwood, K, Mintzer, J, Truyen, L, Wessel, T, Wilkinson, D. Effects of a flexible galantamine dose in Alzheimer's disease: a randomised, controlled trial. J Neurol Neurosurg Psychiatry. 2001;71:589595.CrossRefGoogle ScholarPubMed
52. Rogers, SL, Farlow, MR, Doody, RS, Mohs, R, Friedhoff, LT. A 24-week, double-blind, placebo-controlled trial of donepezil in patients with Alzheimer's disease. Donepezil Study Group. Neurology. 1998;50:136145.CrossRefGoogle Scholar
53. Rogers, SL, Doody, RS, Mohs, RC, Friedhoff, LT. Donepezil improves cognition and global function in Alzheimer disease: a 15-week, double-blind, placebo-controlled study. Donepezil Study Group. Arch Intern Med. 1998;158:10211031.CrossRefGoogle Scholar
54. Winblad, B, Engedal, K, Soininen, H, et al. A 1-year, randomized, placebo-controlled study of donepezil in patients with mild to moderate AD. Neurology. 2001;57:489495.CrossRefGoogle ScholarPubMed
55. Corey-Bloom, J, Anand, R, Veach, J, for the ENA 713 B352 Study Group. A randomized trial evaluating the efficacy and safety of ENA 713 (rivastigmine tartrate), a new acetylcholinesterase inhibitor, in patients with mild to moderately severe Alzheimer's disease. Int J Geriatr Psychopharmacol. 1998;1:5565.Google Scholar
56. Rosler, M, Anand, R, Cicin-Sain, A, et al. Efficacy and safety of rivastigmine in patients with Alzheimer's disease: international randomised controlled trial. BMJ. 1999;318:633638.CrossRefGoogle ScholarPubMed
57. Blesa, R. Galantamine: therapeutic effects beyond cognition. Dement Geriatr Cogn Disord. 2000;11(suppl 1):2834.CrossRefGoogle ScholarPubMed
58. Borson, S, Papadopoulos, G. ReminylTM (galantamine) provides benefits to caregivers of Alzheimer's disease patients over 12 months. Poster presented at: annual meeting of the International Psychogeriatric Association; September 9-14, 2001; Nice, France.Google Scholar
59. Sano, M, Wilcock, GK, Van Baelen, B, Kavanagh, S. The effects of galantamine treatment on caregiver time in Alzheimer's disease. Int J Geriatr Psychiatry. 2003;18:942950.CrossRefGoogle ScholarPubMed
60. Hager, K, Schwalen, S. ReminylTM (galantamine) benefits patients with mild Alzheimer's disease and their caregivers. Poster presented at: 10th Congress of the International Psychogeriatric Association; September 9-14, 2001; Nice, France.Google Scholar
61. Cummings, JL, Mega, M, Gray, K, et al. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology. 1994;44:23082314.CrossRefGoogle ScholarPubMed
62. Tariot, PN, Truyen, L. Reminyl (galantamine) reduces caregiver distress. Poster presented at: 10th Congress of the International Psychogeriatric Association; September 9–14, 2001; Nice, France.Google Scholar
63. Mizuno, T, Endo, Y, Arita, J, Kimura, F. Acetylcholine release in the rat hippocampus as measured by the microdialysis method correlates with motor activity and exhibits a diurnal variation. Neuroscience. 1991;44:607612.CrossRefGoogle ScholarPubMed
64. de Jesus Cabeza, R, Zoltoski, RK, Gillin, JC. Biochemical pharmacology of sleep. In: Chokroverty, S, ed. Sleep Disorders Medicine: Basic Science, Technical Considerations, and Clinical Aspects. 2nd ed. Boston, Mass: Butterworth-Heinemann; 1999:3755.Google Scholar
65. Burns, A, Rossor, M, Hecker, J, et al. The effects of donepezil in Alzheimer's disease—results from a multinational trial. Dement Geriatr Cogn Disord. 1999;10:237244.CrossRefGoogle ScholarPubMed
66. Stahl, SM, Markowitz, JS, Gutterman, EM, Papadopoulos, G. Co-use of donepezil and hypnotics among Alzheimer's disease patients living in he community. J Clin Psychiatry. 2003;64:466472.CrossRefGoogle Scholar
67. Stahl, SM, Markowitz, JS, Gutterman, Em, Papadopoulos, G, Sadik, K. Examination of night-time sleep-related during double-blind, placebo-controlled trials of galantamine in patients with Alzheimer's disease. CMRO. 2004;20:16.Google Scholar
68. Markowitz, JS, Gutterman, EM, Lilienfeld, S, Papadopoulos, G. Sleep-related outcomes in persons with mild to moderate Alzheimer disease in a placebo-controlled trial of galantamine. Sleep. 2003;26:602606.CrossRefGoogle Scholar
69. Acton, GJ, Winter, MA. Interventions for family members caring for an elder with dementia. Annu Rev Nurs Res. 2002;20:149179.Google Scholar
70. Winblad, B, Wimo, A. Assessing the societal impact of acetylcholinesterase inhibitor therapies. Alzheimer Dis Assoc Disord. 1999;13(suppl 2):S9S19.Google ScholarPubMed

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