IMAGING CARE REQUIREMENTS: USE OF FUNCTIONAL HMPAO-SPECT SCANNING TO PREDICT CAREGIVER BURDEN

Abstract

Dementia caregivers frequently report high levels of stress, with increased caregiver burden associated with worse outcomes for both patients and caregivers. Although many studies show how clinical phenotypes relate to caregiver burden, there is little information as to how pathological deficits seen on imaging may relate to caregiver burden, regardless of diagnosis. This study aimed to investigate the relationship between caregiver burden and regional functional deficits on perfusion imaging. 77 consecutive individuals recruited to the BraIID study with cognitive impairment undergoing HMPAO-SPECT imaging as part of their normal clinical care, and their close companions, were recruited to the study. Caregiver burden was measured using the Zarit Burden Interview Questionnaire, completed by the companion at the time of imaging. Total burden score was ranked as little or no burden, mild to moderate burden, or moderate to severe burden. Patient perfusion SPECT images were obtained and pre-processed using SPM8. Imaging perfusion values were extracted for pre-defined regions of interest for each individual, and individual images were also rated as normal or abnormal when compared to 31 controls. Associations between global and regional imaging scores and caregiver burden groups were tested. Caregiver burden group ranking was significantly associated with abnormal / normal frontal perfusion rating (p<0.05) in chi-square analysis, but not with global, parietal or temporal lobe function. Total Zarit burden score significantly correlated with right sided temporal (p<0.05), right sided parietal (p<0.05), and both right and left sided frontal (p<0.01) perfusion values. A significant difference in mean frontal and temporal perfusion was also found between Zarit caregiver burden groups (p<0.01). Caregiver burden is strongly related to the extent of frontal lobe dysfunction, and with right hemisphere parietal and temporal regions. Cross-sectional imaging can be used to facilitate identification at diagnosis of individuals who are likely to create high burden on caregivers, and offers an opportunity to predict and prioritise a need for additional caregiver support in this group.