Neuropsychiatric and Associated Symptoms and Their Management in Caregivers of Alzheimer's Disease Patients: A Systematic Review and Meta-Analysis.

Abstract

Alzheimer's disease (AD) patients' caregivers often experience neuropsychiatric and other associated symptoms due to the high physical and emotional demands of caregiving. Therefore, this meta-analysis aimed to evaluate the prevalence of these symptoms and the impact of various interventions on the reduction of these symptoms. Different electronic databases, like PubMed, Scopus, ScienceDirect, and Google Scholar, were used for the search of literature using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The data obtained was analyzed qualitatively to summarize the general characteristics. Meanwhile, quantitative data were analyzed using Jamovi [The jamovi project (2025), jamovi (Version 2.6) Computer Software] and RevMan 5.4 (The Cochrane Collaboration, 2020), and forest plots were generated. In addition, funnel plots were used to describe the publication bias, and for the certainty of evidence, Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used. Methodological quality assessment was performed using the Cochrane Risk of Bias (RoB-2.0) tool for randomized trials and for non-randomized trials, RoB for non-randomized Studies-Intervention (ROBINS-I). After screening, 31 studies were included in the analysis. Two types of neuropsychiatric symptoms, such as anxiety and depression, were identified. The pooled prevalence effect size was 0.40 (95% CI, 0.28-0.52, <i>I²</i> =89.88%, p<0.01) and 0.43 (95% CI, 0.28-0.52, <i>I²</i> =91.16%, p<0.01), indicating a moderate effect, and showed that 40% and 43% of caregivers experienced anxiety and depression, respectively during the care of AD patients. While a non-significant difference (p>0.01) was observed when different assessment tools were compared for the impact of various interventions, with the effect size of -0.10 (95% CI, -0.96 to 0.76) and substantial heterogeneity (<i>I²</i> =64%). No publication bias and methodological studies were found with low RoB; some concerns. However, some of the studies showed high RoB. Certainty of evidence was found to be moderate to high according to the GRADE framework. Neuropsychiatric symptoms are prevalent among the caregivers of AD, highlighting the need for personalized and standardized evidence-based interventions for the improvement of the well-being of the caregivers.