Burden is a negative psychological state induced in caregivers by the demands of providing care to a person with an illness or a disability. Managing caregiver burden in Parkinson disease (PD) is significant because informal caregivers make a substantial contribution to the well-being of persons with PD, incurring financial, social, and personal losses. Failure to recognize and manage caregiver burden may lead to burnout and premature institutionalization of the person with PD. We conducted a comprehensive literature review to identify and summarize factors that may amplify burden, including motor and nonmotor symptoms of PD, caregiver psychiatric symptoms, and caregiver coping style. We review instruments designed to sample the construct of burden among caregivers and evaluate interventions that may reduce burden, either by directly targeting caregivers or by treating PD symptoms associated with burden. We aim to provide a concise synopsis of these issues for the clinician or researcher working with this population in order to facilitate recognition of caregiver burden, provide accurate assessment, administer appropriate interventions, and stimulate further research in this area.

We focus on Humphreys and Sui's postulations that self-reference effects are not necessarily pre-attentive, and the self and top-down attention interact in the SAN. If so, top-down factors (goal-relevance, directed attention) should interact with self-reference effects. Our pilot data from unspeeded reach-to-grasp actions show differences in trajectories when reaching toward self- or other-relevant objects. We speculate that goal-directed actions are suited to studying the top-down control in self-reference effects. Because goal-directed action paradigms allow broad scope for modulating attention and top-down control, they will be useful for disambiguating the roles of directed attention, inhibition, and (social) context.

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