Role of Gated SPECT MPI in Follow-up of Patients afterCoronary Revascularization

Objective: Gated SPECT myocardial perfusion imaging (GSMPI) is a preferred modality for non invasive assessment following coronary revascularization (CR) of both symptomatic and asymptomatic patients. This study was conducted to observe the impact of GSMPI results on further management of patients who after CR had underwent GSMPI at National Institute of Nuclear Medicine and Allied Sciences (NINMAS). Patients and methods: Record files of GSMPI of all patients who underwent GSMPI over a period of 31 months from June 2011 to December 2013 at NINMAS for assessment of perfusion after CR were selected from the Nuclear Cardiology Divisional archive of patient studies in order to retrieve their clinical and demographic data including the contact numbers. The results of GSMPI scan were categorized as normal scan (NS) and perfusion defect (PD) which included reversible and/or fixed PD. All the contact numbers were called up by a nuclear medicine physician who conducted a semi-structured telephonic interview either with the patients or with a concerned family member. Management strategies adopted after GSMPI were categorized as conservative (CM) and interventional (IM).Cramer’s V (φc) test were done to find strength of relation among patients’ symptoms, scan findings and management strategies. Results: Follow up data of 55 patients (54M, 1F) among 68 (66M, 2F) were available who underwent MPI for the purpose of post CR assessment. MPI was performed in between six months to 13 years after CR (mean 43.8 ± 48.2 months). Categorically 33 patients had percutaneous transluminal coronary angioplasty (PTCA) with stent, 16 patients had coronary artery by-pass grafting (CABG) and 6 patients had both CABG & PTCA. There were 38PD (27symptomatic) and 17NS(12 symptomatic).Since all patients (n=12) who had fixed PD were symptomatic, a strong relation was found between being symptomatic and fixed perfusion defect (φc> 0.3). Symptoms were found to be weakly related with reversible PD i.e. ischemia (φc< 0.2). Management strategies were conservative in 44 (30 symptomatic and 28 PD) and interventional in 11 (nine symptomatic and 10 PD). Management strategies were found to be weakly related with symptoms (φc< 0.2) but moderately related with perfusion status (φc = 0.24). Conclusions: While symptoms were observed to be poorly related with perfusion status following CR, GSMPI guided to choose further interventional management strategies with rationality in lower proportion of patients. Bangladesh J. Nuclear Med. 22(1): 30-35, Jan 2019

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CEA, CA15.3 and 18-FDG PET in the follow-up of early breast cancer (BC) patients (pts): A prospective, multicentric, randomized trial—KRONOS patient-oriented new surveillance study Italy.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.tps11627 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. TPS11627-TPS11627 ◽

Cited By ~ 1

Author(s):

Claudio Zamagni ◽

Massimo Gion ◽

Luigi Mariani ◽

Petra Stieber ◽

Daniela Rubino ◽

...

Keyword(s):

Breast Cancer ◽

Randomized Trial ◽

Fdg Pet ◽

Distant Metastases ◽

Primary Treatment ◽

Asymptomatic Patients ◽

Clinical Scenarios ◽

New Findings ◽

The Impact

TPS11627 Background: Current recommendations for breast cancer (BC) surveillance in asymptomatic patients (pts) include only mammography and physical examination and arise from two trials conducted in the 80’s. Since then new findings about BC biology, treatment and the introduction of cutting-edge diagnostic technologies such as 18-FDG PET have deeply modified our clinical scenarios. The aim of this prospective randomized trial is to verify if the serial measurement of CEA and CA15-3 followed by 18-FDG PET can anticipate the diagnosis of BC recurrence compared to control arm by estimation of the difference of restricted mean survival time (RMST) between the two arms. If the end-point will be met a subsequent extension trial will investigate the impact of the earlier diagnosis of distant metastases on survival. Methods: Pts diagnosed with stage I-III BC, who underwent adequate surgery are eligible. Special histologies and low-risk cases according to St. Gallen criteria are excluded. The study includes pts at the beginning of the follow-up after the conclusion of primary treatment (cohort 1), and pts that have concluded without relapse the first 5 years of follow-up (cohort 2). Eligible pts will be randomized in a 1:1 ratio to follow-up according to local practice (control arm) or to three-monthly serial dosing of CEA and CA15-3 and subsequent 18 FDG-PET only in case of an increase of CEA and/or CA 15.3 greater than a critical difference compared to baseline (experimental arm). The following stratification factors will be used: node negative vs positive, HER2 negative vs positive, ER positive vs negative. Eight-hundred pts will be enrolled over 3 years. For such a calculation, we made the assumption of a 20% baseline 5-year incidence of relapse. The target reduction of three months in RMST implies a median time of diagnostic anticipation, conditional on having BC recurrence, of 10 months. The follow-up will continue until 10 years from surgery. Since 23rd October 2014 573 pts have been enrolled. The present trial was approved by the Ethical Committee of each participating centre and is registered on Clinical trial information: NCT02261389.

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Does routine ultrasound change management in the follow-up of patients with vesicoureteral reflux?

Canadian Urological Association Journal ◽

10.5489/cuaj.202 ◽

2013 ◽

Vol 7 (7-8) ◽

pp. 467 ◽

Cited By ~ 1

Author(s):

Jan K. Rudzinski ◽

Bryce Weber ◽

Petra Wildgoose ◽

Armando Lorenzo ◽

Darius Bagli ◽

...

Keyword(s):

Vesicoureteral Reflux ◽

Demographic Data ◽

Multivariable Analysis ◽

Renal Ultrasound ◽

Dysfunctional Voiding ◽

Voiding Symptoms ◽

Previous Diagnosis ◽

History Of ◽

The Impact

Introduction: Children with vesicoureteral reflux (VUR) usually need a renal ultrasound (RUS). There is little data on the role of follow-up RUS in VUR. We evaluated the impact of follow-up RUS on the change in clinical management in patients with VUR.Methods: We prospectively analyzed children with a previous diagnosis of VUR seen in the outpatient clinic with a routine follow-up RUS within 4 months. Variables collected included: demographic data, VUR history, dysfunctional voiding symptoms and concurrent ultrasound findings. Change in management was defined as addition of new medication, nurse counselling, surgery or further investigations.Results: The study included 114 consecutive patients. The mean patient age was 4.5 years old, mean age of VUR diagnosis was 1.7 years, with average follow-up of 2.8 years. A change in management with stable RUS occurred in 14 patients, in which the change included ordering a DMSA in 9, nurse counselling for dysfunctional voiding in 3, and booking surgery in 2 patients. Change on RUS was seen in 4 patients. Multivariable analysis showed that history of urinary tract infection (UTI) since the last follow-up visit was more significant than RUS findings.Conclusions: The RUS findings in most patients followed for VUR remain stable or with minimal changes. The variable showing a significant effect on change in management in our study was history of UTI since the last follow-up visit rather than RUS findings. The value of follow-up RUS for children with VUR may need to be revisited.

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OP17 Impact of phenotypic and genetic factors on Crohn’s Disease evolution in a cohort of 13,926 patients

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab075.016 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S016-S017

Author(s):

Q Zhang ◽

L Fachal ◽

R Shawky ◽

M Parkes ◽

C Anderson ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Disease Progression ◽

Management Strategies ◽

Standards Of Care ◽

Disease Evolution ◽

The Impact ◽

Disease Location ◽

Over Time

Abstract Background Patients with Crohn’s disease (CD) can develop complications including stricturing and penetrating disease [1, 2]. Although reliable baseline predictors of disease progression are urgently needed to inform management strategies, few studies have comprehensively explored the phenotypic and genetic determinants of disease progression in a sufficiently powered cohort. Methods We used data from 13,926 patients with CD in the UK IBD BioResource to investigate the effects of clinical phenotypes and genetics on CD progression. Median follow-up was 10.6 years and total follow-up was 193,033 patient-years. We applied the Montreal classification system to define disease as B1 (inflammatory), B2 (stricturing) and B3 (penetrating). Patients with B2 or B3 disease (N = 5,185) were compared to patients with B1 disease (N = 8,471) in a multivariate model fitted with both phenotype data and a polygenic score that we developed. Associations with q-values (false discovery rate adjusted p-values) less than 0.05 were defined as statistically significant. Results CD progression occurred over time from diagnosis (Figure 1). Consistent with previous findings, we confirmed factors including smoking, disease location and perianal disease were associated with disease progression [3] (Table 1). The impact of a genetic influence on disease progression was confirmed and shown to be independent of genetic effects on disease location [4]. Early prescription of medications showed a protective effect on disease progression: Infliximab, adalimumab and thiopurines significantly reduced the chance of B2/B3 progression when prescribed within two years of diagnosis. Additionally, we observed a decreased progression to B2/B3 disease in patients diagnosed recently (between 2012–2020) compared to those diagnosed before 2012. This finding persisted after conditioning on exposure to biologics and correcting for follow-up time and interval to first thiopurine prescription, and thus may be indicative of other improvements in standards of care in recent years. Conclusion Using a large, well-characterised cohort we confirm the importance of disease location, smoking status and genetics on disease progression. We highlight the positive impact of early medication prescription on disease progression and discover an independent signal relating to potential improvements in the standard of care in CD over time. These results create the framework for reliable predictors of CD progression that may better guide future CD management strategies. References

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The impact of catheter ablation for patients with asymptomatic atrial fibrillation: subanalysis of kansai plus atrial fibrillation (kpaf) registry

European Heart Journal ◽

10.1093/ehjci/ehaa946.0442 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M Pak ◽

A Kobori ◽

S Shizuta ◽

Y Sasaki ◽

T Toyota ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Primary Endpoint ◽

Hazard Analysis ◽

Secondary Endpoint ◽

Asymptomatic Patients ◽

Significant Difference ◽

Secondary Endpoints ◽

The Impact

Abstract Background Catheter ablation (CA) of atrial fibrillation (AF) for symptomatic patients improves the quality of life and prognosis of patients with heart failure. However, the impact of CA for asymptomatic patients is still controversial. Purpose We aimed to investigate the clinical outcomes of CA of AF for asymptomatic patients compared to those for symptomatic patients. Methods A total of 5,013 patients from the Kansai Plus Atrial Fibrillation (KPAF) Registry who underwent CA were screened. The patients were divided into three groups by type of AF; paroxysmal (PAF), persistent (PEAF) and long standing (LSAF) and the patients in each type of AF were divided into two groups: asymptomatic and symptomatic. The primary endpoint was recurrent supraventricular tachyarrhythmias lasting for more than 30 seconds during follow-up 4 years after CA. The secondary endpoint was a composite of cardiovascular, cerebral, and gastrointestinal events during follow-up 4 years after CA. The incidence of complications related to CA between asymptomatic and symptomatic patients was also evaluated. Kaplan–Meier analysis was employed to estimate the primary and secondary endpoints. The statistical differences in primary and secondary endpoints between asymptomatic and symptomatic patients were evaluated using a log–rank test. The impact of symptom due to AF on the primary and secondary endpoint was evaluated using a Cox hazard analysis. The difference in incidence of complications between asymptomatic and symptomatic patients was evaluated using a chi–square test. Results In this study population, PAF was the most frequent at 64.4%, followed by PEAF (22.7%) and LSAF (13.0%). There were some significant differences in the baseline characteristics between asymptomatic and symptomatic patients in each type of AF. The proportion of male was significantly higher in asymptomatic patients than symptomatic patients in PAF (81.2% versus 67.2%, p<0.001) and PEAF (86.4% versus 74.3%, p<0.001). Left atrial diameter was larger in asymptomatic patients than symptomatic patients only in PAF (40±6mm versus 38±6mm, p<0.001). In all types of AF, there was no significant difference in primary endpoint between asymptomatic and symptomatic patients as follows: 37.5% versus 40.6% (p=0.6) in PAF, 45.2% versus 55.1% (p=0.09) in PEAF and 59.3% versus 63.6% (p=1.0) in LSAF. There was also no significant difference in secondary endpoint between asymptomatic and symptomatic patients: 7.1% versus 6.8% (p=0.7) in PAF, 5.4% versus 8.7% (p=0.3) in PEAF and 4.4% versus 5.1% (p=0.5) in LSAF. In a Cox hazard analysis, the symptom did not affect both of the primary and secondary endpoints in each type of AF. In regard to the incidence of complications related to CA, there was no significant difference between asymptomatic and symptomatic patients in each type of AF. Conclusion CA of AF for asymptomatic patients can be safe and can lead to equivalent outcomes as well as symptomatic patients. Funding Acknowledgement Type of funding source: None

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The Impact of COVID-19 Pandemic on Children with Pulmonary Arterial Hypertension. Parental Anxiety and Attitudes. Follow-Up Data from the Polish Registry of Pulmonary Hypertension (BNP-PL)

Journal of Clinical Medicine ◽

10.3390/jcm10081640 ◽

2021 ◽

Vol 10 (8) ◽

pp. 1640

Author(s):

Joanna Kwiatkowska ◽

Jaroslaw Meyer-Szary ◽

Anna Mazurek-Kula ◽

Malgorzata Zuk ◽

Anna Migdal ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Pulmonary Arterial Hypertension ◽

Arterial Hypertension ◽

Social Impact ◽

Demographic Data ◽

General Anxiety Disorder ◽

General Anxiety ◽

Pulmonary Arterial ◽

The Impact

The COVID-19 pandemic has impacted healthcare systems worldwide. Little is known about the impact of the pandemic on medical and psycho-social aspects of children with rare diseases such as pulmonary arterial hypertension and their parents. The study is based on children registered in The Database of Pulmonary Hypertension in the Polish Population and a parent-reported survey deployed during the first 6 months of the pandemic. The questionnaire consisted of six question panels: demographic data, fear of COVID-19, General Anxiety Disorder-7 (GAD-7), social impact of pandemic, patients’ medical status, and alarming symptoms (appearance or exacerbation). Out of 80 children registered, we collected 58 responses (72.5% response rate). Responders (parents) were mostly female (n = 55; 94.8%) at a mean age of 40.6 ± 6.9 years. Patients (children) were both females (n = 32; 55%) and males with a mean age of 10.0 ± 5.1 years. Eleven (19%) children had symptoms of potential disease exacerbation. Eight parents (72.7%) decided for watchful waiting while others contacted their GPs or cardiologists (n = 6; 54.5%). Three children had to be hospitalized (27.3%). Most planned hospitalizations (27/48; 56.2%) and out-patient visits (20/35; 57.1%) were cancelled, delayed, or substituted by telehealth services. Among the participating parents, the study shows very high levels of anxiety (n = 20; 34.5%) and concern (n = 55; 94.8%) and the need for detailed information (52; 89.6%) regarding COVID-19 and medical service preparedness during the pandemic. The COVID-19 pandemic has influenced child healthcare and caused high levels of anxiety among parents.

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Queensland Cardiovascular Data Linkage (QCard): A population-based cohort study

F1000Research ◽

10.12688/f1000research.23261.1 ◽

2020 ◽

Vol 9 ◽

pp. 282 ◽

Cited By ~ 1

Author(s):

Joshua Byrnes ◽

Son Nghiem ◽

Clifford Afoakwah ◽

Paul A. Scuffham

Keyword(s):

Cohort Study ◽

Demographic Data ◽

Healthcare Utilisation ◽

Population Based ◽

Environmental Data ◽

Cardiac Patients ◽

Hospital Inpatient ◽

Healthcare Use ◽

The Impact

Queensland is Australia's hotspot for cardiovascular disease (CVD). Critically, beyond modifiable lifestyle risk factors; socio-demographic differences and environmental factors account for significant variations in healthcare use and outcomes among cardiac patients across the country. To better understand the impacts of these factors on the health of cardiac patients, there is a need for a comprehensive and robust longitudinal cohort study that can unpack the underlying dynamics. This paper describes the protocol for the Queensland Cardiovascular Linkage (QCard) Study. The QCard is a longitudinal linkage cohort study of cardiac patients who were first hospitalised with any cardiac condition in 2010, with follow up hospitalisations until December 2015. The primary aim of the QCard is to identify and characterise the nature and impact of socio-demographic inequality among those presenting for the first time with the most common form of CVD in Australia (heart disease) in Queensland from 2010 with minimum 5-years follow-up of subsequent healthcare utilisation and outcomes. A secondary aim is to undertake an exploration of the impact of environmental and specific health service factors on healthcare use and survival time in the same QCard cohort. Administrative public and private hospital inpatient, outpatient and emergency department data for all of Queensland will be linked with individual primary care data and pharmaceutical data. These data will also be linked to regional socio-demographic data and environmental data, as well as data that describes the features of each hospital in the region. The findings from the study will provide critical information for cardiac patients, clinicians and health policymakers. Such information ranges from identifying most vulnerable cardiac patients who may require targeted needs to providing estimates for cost-effective ways of evaluating healthcare interventions that seek to improve the health of cardiac patients.

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One Year Later: Global Impact of COVID-19 on Nuclear Medicine Departments; an International Follow-up Survey

10.21203/rs.3.rs-459551/v1 ◽

2021 ◽

Author(s):

Francesco Giammarile ◽

Roberto C. Delgado Bolton ◽

Noura El Haj ◽

Lutz S. Freudenberg ◽

Ken Herrmann ◽

...

Keyword(s):

Nuclear Medicine ◽

Energy Agency ◽

Web Based ◽

Income Status ◽

The World ◽

Therapeutic Procedures ◽

Nuclear Medicine Procedures ◽

One Year ◽

The Impact

Abstract Aim: As a follow-up to the international survey conducted in April 2020, this survey aims to provide a situational snapshot of the COVID-19 impact on nuclear medicine services worldwide, one year later. The survey was designed to determine the impact of the pandemic at two specific time-points: June and October 2020 and compare them to the previously collected data.Materials and Methods: A web-based questionnaire, in the same format as the April 2020 survey was disseminated to nuclear medicine facilities worldwide. Survey data was collected using a secure software platform hosted by the International Atomic Energy Agency (IAEA); it was made available for 6 weeks, from November 23 to December 31, 2020.Results: From 505 replies from 96 countries, data was extracted from 355 questionnaires (of which 338 were fully completed). The responses came from centres evenly distributed in different regions of the world and with different income status. Regional differences and challenges across the world were identified and analysed. Globally, the volume of nuclear medicine procedures decreased by 73.3% in June 2020 and 56.9% in October 2020. Among the nuclear medicine procedures, oncological PET studies showed less of a decline in utilization compared to conventional nuclear medicine and particularly nuclear cardiology. The impact was also significantly less in high-income countries. A trend towards a return to the pre-COVID-19 situation of the supply chains of radioisotopes, generators, and other essential materials was evident.Conclusion: The impact of the COVID-19 pandemic was associated with a significant reduction in nuclear medicine diagnostic and therapeutic procedures throughout 2020. In June, the global decline recorded in the survey was greater than in October when there was a slight improvement. However, the total number of procedures continued below that recorded in April 2020, and less than half of the volumes normally carried out before the pandemic

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The impact of COVID-19 pandemic on pediatric rheumatology patients under immunosuppressive therapy: A single-center experience

10.21203/rs.3.rs-36583/v1 ◽

2020 ◽

Author(s):

Oya Koker ◽

Fatma Gul Demirkan ◽

Gulsah Kayaalp ◽

Figen Cakmak ◽

Ayse Tanatar ◽

...

Keyword(s):

Current Knowledge ◽

Demographic Data ◽

Immunosuppressive Treatment ◽

Connective Tissue Diseases ◽

Additional Risk ◽

Entire Cohort ◽

Single Center Experience ◽

Policy Transmission ◽

The Impact

Abstract Objective: The aim of the research was to further broaden current knowledge of whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease 2019 (COVID-19) entails a risk for children with rheumatic diseases regarding immunosuppressive treatment.Methods: Telephone-survey was administered by conducting interviews with the parents. A message containing a link to the actual questionnaire was sent to their phones simultaneously. The medical records of the patients were reviewed for gathering information about demographic data, clinical follow-up, and treatments.Results: Patients who were followed up with immunosuppressive treatment (n=439) were attempted to be contacted between 1 May 2020 and 15 May 2020. The diagnostic distribution of patients who were accessible and eligible for the study was as follows; juvenile idiopathic arthritis (JIA) (n=243, 58.7%), autoinflammatory diseases (n=109, 26.3%), autoimmune connective tissue diseases (n=51, 12.3%) and vasculitis (n=11, 2.7%). In the entire cohort, the mean age was 12 ± 4.7 years, and 54.1% (n=224) of the patients were female. One patient with seronegative polyarticular JIA, previously prescribed methotrexate and receiving leflunomide during pandemic has been identified to be diagnosed with COVID-19. None of the patients, including the patient diagnosed with COVID-19, had any severe symptoms. More than half of the patients with household contacts required hospitalization as they were asymptomatic.Conclusion: Although circumstances such as compliance in social distancing policy, transmission patterns, attitude following contact may influence the results, immunosuppressive treatment does not seem to pose additional risk in terms of COVID-19.

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Neuropsychological assessments before and after awake surgery for incidental low-grade gliomas

Journal of Neurosurgery ◽

10.3171/2020.7.jns201507 ◽

2020 ◽

pp. 1-10

Author(s):

Sam Ng ◽

Guillaume Herbet ◽

Anne-Laure Lemaitre ◽

Jérôme Cochereau ◽

Sylvie Moritz-Gasser ◽

...

Keyword(s):

Cognitive Domain ◽

Awake Surgery ◽

Consecutive Series ◽

Low Grade ◽

Asymptomatic Patients ◽

Z Scores ◽

Neuropsychological Assessments ◽

Neuropsychological Outcomes ◽

The Impact

OBJECTIVEEarly surgery in presumed asymptomatic patients with incidental low-grade glioma (ILGG) has been suggested to improve maximal resection rates and overall survival. However, no study has reported on the impact of such preventive treatment on cognitive functioning. The aim of this study was to investigate neuropsychological outcomes in patients with ILGG who underwent preventive surgery.METHODSThis was a retrospective analysis of a consecutive series of patients with ILGG who underwent awake surgery and who had presurgical and 3-month postsurgical neuropsychological assessments. Data were normalized into z-scores and regrouped by cognitive domains. Clinicoradiological data, histomolecular profile, and differences in z-scores (Δz-scores) were analyzed.RESULTSForty-seven patients were included (mean age 39.2 ± 11.3 years). Twenty-eight patients (59.6%) underwent supratotal or total resections. All patients were still alive after a mean follow-up of 33.0 ± 30.8 months. Forty-one patients (87.2%) had stable (n = 34, 72.3%) or improved (Δz-score > 1; n = 7, 14.9%) neurocognitive outcomes after surgery. Six patients (12.8%) presented a slight impairment (Δz-score < −1) in at least one cognitive domain. The mean presurgical and postsurgical z-scores were comparable except in the psychomotor speed and attention domain. A significant correlation between presurgical executive functioning and tumor volume was reported, whereas the extent of resection and histomolecular profile did not impact neuropsychological outcomes.CONCLUSIONSEarly surgical treatment in presumed asymptomatic patients with ILGG was associated with stable or improved neuropsychological outcomes in 87.2% of patients at 3 months, with only mild cognitive decline observed in 6 patients. In return, supratotal or total resections were achieved in most patients, and all patients were still alive at the end of the follow-up.

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Informal caregiving for dementia patients: the contribution of patient characteristics and behaviours to caregiver burden

Age and Ageing ◽

10.1093/ageing/afz128 ◽

2019 ◽

Vol 49 (1) ◽

pp. 52-56 ◽

Cited By ~ 4

Author(s):

Andrew P Allen ◽

Maria M Buckley ◽

John F Cryan ◽

Aoife Ní Chorcoráin ◽

Timothy G Dinan ◽

...

Keyword(s):

Caregiver Burden ◽

Management Strategies ◽

Patient Characteristics ◽

Informal Caregiving ◽

Hierarchical Regression ◽

Safety Issues ◽

Carer Burden ◽

Challenging Behaviours ◽

The Impact

Abstract Objectives The burden often associated with informal caregiving for patients with dementia is associated with negative effects on health, both physiologically and in terms of caregiver cognition. There is wide variation in the level of burden experienced by dementia caregivers. To better understand caregiver burden, it is thus important to understand the factors associated with level of burden. Methods In the current study, we collected carer burden and putative associated factors at baseline, 6 and 12 months. Hierarchical regression was used to assess the impact of these factors on caregiver burden. We assessed self-reported carer burden, patient behavioural and safety issues, and level of difficulty associated with providing assistance with activities of daily living (ADL). Patients’ age was also recorded, and trained nurses assessed patient cognitive performance using the quick mild cognitive impairment screen. Results At baseline, patients’ age, cognition and ADLs were associated with burden, and safety and challenging behaviour were both significantly associated with burden independent of the other factors. Change in burden was associated with change in carer-reported safety at 6-month follow-up, and with change in safety and change in carer-reported challenging behaviours at 12-month follow-up. Conclusions Safety issues and challenging behaviours are associated with carer burden, even after accounting for cognitive and functional impairment in the person with dementia. As dementia progresses, monitoring these factors may help to inform stress-management strategies for caregivers.

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