Systematic Review and Meta-Analysis of Psychological and Behavioral Symptoms in Alzheimer’s Disease and Their Impact on Professional Caregiver Burden

Background Alzheimer's disease is a progressive neurodegenerative disorder associated with cognitive decline and psychological and behavioral symptoms (PBSA), which significantly impact both patients and professional caregivers. Despite their central role in managing PBSA, limited research has evaluated caregivers’ knowledge of these symptoms and the burden they experience. Understanding caregivers’ perceptions and the intensity of PBSA is essential to improving care quality and caregiver well-being. Methods A systematic review and meta-analysis were conducted following PRISMA guidelines. Databases searched included PubMed, PsycINFO, and Google Scholar up to December 2024. Of 918 identified records, 56 studies met inclusion criteria. Data extraction was conducted using CADIMA, and statistical analyses were performed with the “METAFOR” package in R. Pooled effect sizes of mean Neuropsychiatric Inventory (NPI) subdomain scores were calculated to assess symptom intensity. A mixed-effects meta-regression examined whether sample size influenced caregiver burden variability. Results Agitation (pooled mean = 2.90; 95% CI [0.64, 5.17]), depression (15.92; 95% CI [8.89, 22.96]), apathy (9.40; 95% CI [3.48, 22.28]), anosognosia (15.92; 95% CI [8.89, 22.96]), and anxiety (1.72; 95% CI [0.98, 2.46]) were the most intense symptoms. Formal caregivers’ knowledge varied across studies, with pooled means of 2.67 (95% CI [2.02, 3.31]) for symptom knowledge and 6.24 (95% CI [5.02, 7.31]) for treatment knowledge. Substantial heterogeneity was present (I² > 90%). Meta-regression revealed that sample size was not a significant moderator of caregiver burden (estimate = -0.017, p = 0.804), with residual heterogeneity remaining high (I² = 99.85%). Conclusion This review highlights the high prevalence and intensity of PBSA in Alzheimer’s care and underscores the variability in caregiver knowledge and burden. Sample size does not account for differences in reported burden, suggesting the influence of other contextual or organizational factors. These findings emphasize the urgent need for structured education and support programs tailored to formal caregivers to enhance symptom management and reduce burden.