Defining the role of the caregiver in Alzheimer's disease treatment.

The day-to-day responsibility of caring for a person with dementia often exacts a toll upon the caregiver, which may be manifested psychologically, physically, socially and financially. The last decade has witnessed the advent of drug availability for the treatment of Alzheimer's disease, specifically the cholinesterase inhibitors. Caregivers are integral to the initiation, administration and monitoring of treatment. In particular, they provide substitute informed consent when patients are no longer competent to do so. While there is evidence that cholinesterase inhibitors may reduce caregiver burden and time spent assisting patients, there are also burdens associated with being the person responsible for administering medication. Caregivers are key to research into the use of medications for Alzheimer's disease. They have roles in recruitment and consent and monitoring response and adverse effects. Increasingly, caregivers themselves are recognised as legitimate targets for evaluating the efficacy of new pharmacological agents for Alzheimer's disease (as benefits have been demonstrated for them). Caregivers have responsibilities regarding the drug treatment of patients with Alzheimer's disease, and require information about the medications so that they can have realistic expectations. Doctors need to work in partnership with caregivers and patients when prescribing drugs for Alzheimer's disease.