Table 1.

Studies investigating interventional support for caregivers of patients with AD

Reference	Interventions	Study design	Inclusion criteria	Results	Comments/conclusions
Brennan et al., 1995 [51]	Computer-based support as needed (n = 51) vs. control (n = 51)	Randomised controlled 12-month study	Caregiver: primary caregiver, access to telephone, able to read and write in English; Patient: not specified	Caregivers’ decision-making confidence was improved; Caregivers’ decision-making skill was unaffected; No changes in social isolation	Improvements observed in caregivers’ decision-making confidence alone
Mahoney et al., 2003 [21]	Computer-mediated automated interactive voice responsea (n = 49) vs. usual care (n = 51)	Randomised controlled study over a period of 18 months (12 months of treatment and 6 months of follow-up)	Caregiver: ≥18 years, minimum of 4 h care per day for 6 months for patient with impaired ADLs; Patient: MMSE score ≤23	Significant effect of intervention for caregivers with low mastery at baseline, with decreases in the levels of bother (p = 0.04), anxiety (p = 0.01) and depression (p = 0.007) vs. the control group	Caregivers who exhibited low mastery and high anxiety at baseline benefited the most; The authors concluded that, to optimise outcome effects, similar interventions should be individualised to the caregiver
Winter and Gitlin, 2006 [50]	Tele-support linking 5 caregivers per group for 1 h/week (n = 58) vs. usual care (n = 45)	Randomised controlled 6-month study	Caregivers: female, ≥50 years, providing care for ≥6 months, weekly access to telephone for 1 h; Patient: physicians diagnosis of AD or related dementia	Minimal benefits for tele-support vs. usual care: Aged 50–64 years: burden (p = 0.490), gain (p = 0.932), depression (p = 0.121); Aged ≥65 years: burden (p = 0.352), gain (p = 0.086), depression (p = 0.014)	The authors concluded that the benefits of tele-support were minimal and only observed in older female caregivers (aged ≥65 years)
Eisdorfer et al., 2003 [55]	SET (n = 75) vs. SET plus CTIS (n = 77) vs. minimal support (n = 73)	Randomised (stratified according to ethnicity) controlled 18-month study (12 months of treatment plus 6 months of follow-up)	Caregiver: cohabit and provide minimum of 4 h care per day for prior 6 months; Additional family member: provide emotional or instrumental support; Patient: MMSE score <24 with impaired ADLs	Reduction in depression in the SET plus CTIS group at 6 months, which differed according to ethnicity (Cuban American or White American) and relationship to patient	Information technology has a promising role in alleviating distress and depression among groups of AD caregivers; Interventions have differential impacts according to ethnic group and the caregiver-patient relationship
Mittelman et al., 2004 [47]	Multicomponent, individualised counselling and support (n = 203) vs. usual care (n = 203)	Randomised controlled study (results presented for 4-year analysis)	Caregiver: spouse of patient with AD, cohabiting, and with primary responsibility for care	Rates of behaviour problems increased over time and did not differ with intervention method; Caregivers in the control group appraised behaviour as increasingly distressing over the 4-year period; Caregivers in the treatment group rated behaviour as less and less distressing over the same period	The authors concluded that psychosocial intervention can provide caregivers with strategies to help them manage their reactions to behaviour problems more effectively
Martin-Carrasco et al., 2009 [45]	PIP plus standard care (n = 60) vs. standard care aloneb (n = 55)	Multicentre prospective randomised 10-month study (4 months of treatment plus 6 months of follow-up)	Caregiver: minimum of 4 h per day for patient with impaired ADLs and baseline Zarit score >22; Patient: MMSE score 10–26 and receiving rivastigmine (≥6 mg/day) for prior 6 months	Zarit scale: mean score reduction in PIP group greater than in control group (p = 0.0083); SF-36: mean scores significantly higher in PIP than the control group in all the dimensions (p < 0.05) except for mental health	Supports the efficacy of PIP in reducing caregiver burden in AD; The reduction in burden seems to improve the quality of life in relation to health and rates of psychiatric morbidity; The positive effects of PIP continued to last for at least a further 6 months
Burns et al., 2003 [46]	Training in behaviour management (n = 85) vs. training in behaviour management plus training to cope with stress (n = 82)	Randomised (with stratification according to race and gender) 24-month study	Caregiver: >21 years, minimum of 4 h care per day for ≥6 months; Patient: MMSE score <24	Behaviour management plus coping skills improved general well-being (p = 0.004) and depression (p = 0.007) over time	The authors conclude that brief primary care interventions may be effective in reducing caregiver distress and burden in the long-term management of AD patients; Interventions that focus only on care recipient behaviour, without addressing care-giving issues, may not be as adequate for reducing caregiver distress as combined approaches
Mittelman et al., 2008 [49]	Individual and family counselling with ad hoc telephone counselling plus donepezil treatment for patient (n = 79) vs. donepezil alone (n = 79)	Randomised controlled 24-month study (formalised counselling for 3 months followed by ad hoc counselling and follow-up for 21 months)	Caregiver: spouse of patient with AD, cohabiting and self-defined primary caregiver; Patient: probable AD, GDS score 4–5	Caregiver depression was significantly reduced at 3 months in those who received counselling compared with those who did not; The reduction in depression persisted for the entire 24 months of the study; Depression scores for caregivers who did not receive counselling increased over the study period	Effective counselling and support interventions can reduce symptoms of depression in caregivers; The authors recommend combining ChEIs and supportive counselling for patients with AD and their caregivers

ADLs = Activities of daily living; CTIS = computer/telephone-integrated system (information system and tele-support); GDS = Global Deterioration Scale; MMSE = Mini-Mental State Examination; PIP = psychoeducational interventional program; SET = structural ecosystems therapy (family therapy intervention).

^aComprised caregiver stress monitoring and counselling information, personal voice mail linkage to AD experts, a voice mail telephone support group and a distraction call for care recipients.

^bStandard care comprised individual 90-min sessions, at 1- to 2-week intervals over 4 months, providing general information about how AD progresses, individualised information about the patient, both in person and over the telephone ‘on demand’, information leaflets about AD and information about resources directed at caregivers available in their community.