Browsing by Author "Hogan, David B."
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Item Open Access Associations between specialized dementia care, COVID-19 and central nervous system medication use in assisted living: a population-based repeated cross-sectional study(2024-08-14) Maxwell, Colleen J.; Dampf, Hana; Squires, Jillian P.; Hogan, David B.; Cotton, Cecilia A.; MMath, Erik Y.; Hsu, Zoe; Hoben, MatthiasAbstract Background Assisted living (AL) is an increasingly common residential setting for persons with dementia; yet concerns exist about sub-optimal care of this population in AL given its lower levels of staffing and services. Our objectives were to (i) examine associations between AL setting (dementia care vs. other), COVID-19 pandemic waves, and prevalent antipsychotic, antidepressant, anti-dementia, benzodiazepine, and anticonvulsant drug use among residents with dementia/cognitive impairment, and (ii) explore associations between resident and home characteristics and prevalent medication use. Methods We conducted a population-based, repeated cross-sectional study using linked clinical and health administrative databases for all publicly funded AL homes in Alberta, Canada, examined between January 2018 - December 2021. The quarterly proportion of residents dispensed a study medication was examined for each setting and period (pandemic vs. comparable historical [2018/2019 combined]) focusing on four pandemic waves (March-May 2020, September 2020-February 2021, March-May 2021, September-December 2021). Log-binomial GEE models estimated prevalence ratios (PR) for period (pandemic vs. historical periods), setting (dementia care vs. other) and period-setting interactions, adjusting for resident (age, sex) and home (COVID-19 cases, health region, ownership) characteristics. Results On March 1, 2020, there were 2,779 dementia care and 3,013 other AL residents (mean age 83, 69% female) with dementia/cognitive impairment. Antipsychotic use increased during waves 2–4 in both settings, but this was more pronounced in dementia care than other AL during waves 3 and 4 (e.g., adjusted [adj]PR 1.20, 95% CI 1.14–1.27 vs. adjPR 1.09, 95% CI 1.02–1.17, interaction p = 0.023, wave 3). Both settings showed a statistically significant but modest increase in antidepressant use and decrease in benzodiazepine use. For dementia care AL residents only, there was a statistically significant increase in gabapentinoid use during several waves (e.g., adjPR 1.32, 95% CI 1.10–1.59, wave 3). Other than a modest decrease in prevalent anti-dementia drug use for both settings in wave 2, no other significant pandemic effects were observed. Conclusions The persistence of the pandemic-associated increase in antipsychotic and antidepressant use in AL residents coupled with a greater increase in antipsychotic and gabapentinoid use for dementia care settings raises concerns about the attendant risks for residents with cognitive impairment.Item Open Access Attitudes and beliefs about insomnia and insomnia treatment among older adults with chronic insomnia(2000) MacLeod, Mary Annet Krista; Hogan, David B.Item Open Access Creating the Future of Health: The History of the Cumming School of Medicine at the University of Calgary, 1967-2012(University of Calgary Press, 2021-02) Lampard, Robert; Hogan, David B.; Stahnisch, Frank W.; Wright Jr., James R.The first fifty years of innovation in health education at the Cumming School of Medicine at the University of Calgary, drawing on interviews with key players and extensive research into primary documents. Creating the Future of Health is the fascinating story of the first fifty years of the Cumming School of Medicine at the University of Calgary. Founded on the recommendation of the Royal Commission on Health Services in 1964 the Cumming School has, from the very beginning, focused on innovation and excellence in health education. With a pioneering focus on novel, responsive and systems-based approaches, it was one of the first faculties to pilot multi-year training programs in family medicine and remains one of only two three-year medical schools in North America. Drawing on interviews with key players and extensive research into documents and primary material, Creating the Future of Health traces the history of the school through the leadership of its Deans. This is a story of perseverance through fiscal turbulence, sweeping changes to health care and health care education, and changing ideas of what health services are and what they should do. It is a story of triumph, of innovation, and of the tenacious spirit that thrives to this day at the Cumming School of Medicine.Item Open Access An environmental scan of methods for assessing age-friendliness in post-secondary institutions(Taylor & Francis, 2022-11-07) Zimmer, Chantelle; Goerzen, Maya; Hogan, David B.; Toohey, Ann M.The University of Calgary joined the Age-Friendly University (AFU) Global Network in 2018. As part of our university’s AFU action plan, a baseline assessment of the institution’s age-friendliness will be conducted to identify areas of strength and growth. To inform our approach and that of other institutions undertaking this work, an environmental scan was performed to determine methods used by post-secondary institutions to date to assess age-friendliness. Both academic and grey literature published between 2012 and 2022 in the English language was searched using diverse keywords. The academic literature was identified from four databases (Abstracts in Social Gerontology, Academic Search Complete, Education Research Complete, Scopus) and the grey literature from 84 institutional websites of AFU Global Network members. Twelve academic sources and four grey sources were included in the analysis. Seven methods were used to assess age-friendliness, with the most common approaches being surveys, inventories, focus groups, interviews, and photovoice. The Age-Friendly Inventory and Campus Climate Survey (Silverstein et al., 2022) was selected to evaluate the University of Calgary’s age-friendliness due to its alignment with all 10 AFU principles, comprehensiveness, and involvement of multiple stakeholders. Other post-secondary institutions should consider their context and resources when selecting an assessment method.Item Open Access Exploring data reduction strategies in the analysis of continuous pressure imaging technology(2023-03-01) Peng, Mingkai; Southern, Danielle A.; Ocampo, Wrechelle; Kaufman, Jaime; Hogan, David B.; Conly, John; Baylis, Barry W.; Stelfox, Henry T.; Ho, Chester; Ghali, William A.Abstract Background Science is becoming increasingly data intensive as digital innovations bring new capacity for continuous data generation and storage. This progress also brings challenges, as many scientific initiatives are challenged by the shear volumes of data produced. Here we present a case study of a data intensive randomized clinical trial assessing the utility of continuous pressure imaging (CPI) for reducing pressure injuries. Objective To explore an approach to reducing the amount of CPI data required for analyses to a manageable size without loss of critical information using a nested subset of pressure data. Methods Data from four enrolled study participants excluded from the analytical phase of the study were used to develop an approach to data reduction. A two-step data strategy was used. First, raw data were sampled at different frequencies (5, 30, 60, 120, and 240 s) to identify optimal measurement frequency. Second, similarity between adjacent frames was evaluated using correlation coefficients to identify position changes of enrolled study participants. Data strategy performance was evaluated through visual inspection using heat maps and time series plots. Results A sampling frequency of every 60 s provided reasonable representation of changes in interface pressure over time. This approach translated to using only 1.7% of the collected data in analyses. In the second step it was found that 160 frames within 24 h represented the pressure states of study participants. In total, only 480 frames from the 72 h of collected data would be needed for analyses without loss of information. Only ~ 0.2% of the raw data collected would be required for assessment of the primary trial outcome. Conclusions Data reduction is an important component of big data analytics. Our two-step strategy markedly reduced the amount of data required for analyses without loss of information. This data reduction strategy, if validated, could be used in other CPI and other settings where large amounts of both temporal and spatial data must be analysed.Item Open Access Frailty in older adults (≥50 years) living with Human Immunodeficiency Virus (HIV)(2018-07-06) McMillan, Jacqueline Mary; Hogan, David B.; Gill, Michael John; Krentz, Hartmut B.Antiretroviral therapy (ART) has increased the life expectancy of persons living with HIV/AIDS (PLWHA). Fifty percent of PLWHA are ≥ 50 years of age, and age-related comorbidities are an increasing concern. The prevalence of frailty in HIV is greater than in age-matched controls. We investigated a cohort of older (≥ 50 years) PLWHA at the Southern Alberta Clinic (SAC) in Calgary, Alberta, and screened for frailty. Patients were screened using three frailty measures: a Modified Frailty Phenotype, Clinical Frailty Scale and the Frailty Index. Patients identified as frail were offered a Comprehensive Geriatric Assessment performed by a Geriatrician and the results were shared with the HIV provider and the family physician. Over three hundred patients were screened using the MFP and CFS, and over 700 patients had a FI calculated. Frailty was associated with duration of ART, but not with known duration of HIV infection, CD4 cell count, viral load, or age.Item Open Access Hydration Monitoring using Microwaves: From Modelling and Estimation of Tissue Properties to Validation in Humans(2018-09-21) Garrett, David; Fear, Elise C.; Fear, Elise C.; Okoniewski, Michal M.; Kuo, Arthur D.; Hogan, David B.Dehydration is a prevalent condition which can have profound health consequences. If detected early, it can often be treated by oral fluid replacement. A variety of assessment techniques have been proposed, but none have yet emerged as convenient and accurate indicators. This thesis investigates the use of microwave measurements at the extremities to monitor human hydration, relying on the strong relationship between dielectric properties of tissues and water content. A model describing changes in tissue properties according to dehydration is first developed. We then report an empirical feasibility study in athletes undergoing exercise, demonstrating a relationship between estimated permittivity and weight changes due to water loss. Finally, improved property estimation techniques are introduced which are suitable for reliably detecting changes due to dehydration. This thesis provides a comprehensive initial assessment of how microwave measurements may be used to provide the clinically-demanded method of human hydration assessment.Item Open Access Impact of a 6-month aerobic exercise intervention on oxidative stress in sedentary older adults(2018-12-17) Rytz, Chantal Louise; Poulin, Marc J.; Pialoux, Vincent; Hogan, David B.Background: Reactive oxygen species (ROS) play integral roles in cell signalling and systemic processes and are tightly controlled through workings of antioxidants. An imbalance in this relationship can lead to oxidative stress. Completion of regular exercise can mitigate oxidative stress, strengthen antioxidant capacity and improve oxidative stress- associated conditions, such as metabolic syndrome (MetS) and decreased cerebrovascular function. However, there is limited knowledge as to how the aging population with and without MetS compare in terms of changes in markers of oxidative stress and antioxidant profiles with an aerobic exercise intervention, and the effect these changes in have on cerebrovascular function. Objective: We aimed to assess the effects of a 6-month aerobic exercise intervention on markers of oxidative stress and antioxidant capacity in older, sedentary yet healthy adults, and to determine how MetS status affected these exercise-induced changes. Further, as an exploratory measure, we aimed to assess the association between changes in markers of oxidative stress and antioxidant capacity and measures of cerebrovascular function. Design: Blood samples from 206 participants (mean age=66.8 ± SE=6.4 years, 104 females) pre-, midway, and post-intervention were assessed for markers of oxidative stress (advanced oxidation protein products [AOPP; malondialdehyde [MDA]; 3-nitrotyrosine [3-NT]) and antioxidant capacity (superoxide dismutase [SOD]; uric acid [UA]; ferric- reducing ability of ṗ lasma [FRAP]; nitric oxide metabolites [NOx]; catalase). Maximal aerobic capacity (VO2max), anthropometric and demographic information was also collected. Repeated measures linear mixed models adjusted for covariates were used to evaluate changes in markers of oxidative stress and antioxidant capacity across the exercise intervention. Factors represented by changes in markers of oxidative stress and antioxidant status were used in a linear regression analysis to assess the potential association between oxidative stress and cerebrovascular function. Results: There was a significant effect of the exercise intervention on decreasing levels of AOPP (p=0.004) however, neither MetS status (p=0.214) nor sex (p=0.437) modified the effect. Individuals with MetS had significantly higher levels of AOPP (p<0.001), MDA (p<0.001), FRAP (p=0.03) and UA (p=0.003) compared to those without. Men possessed significantly higher levels of AOPP (p=0.001), FRAP (p<0.001), catalase (p=0.013) and UA (p<0.001) compared to women. Interestingly, the effect of MetS status on FRAP and 3-NT was highly dependent on sex. Further, exercise-induced changes in measures of oxidative stress and antioxidant status were significantly associated with post-intervention measures of cerebrovascular function at rest and submaximal exercise. Conclusion: These results indicate that MetS may blunt exercise-induced improvements in oxidative stress and that changes in markers of oxidative stress and antioxidant status may impact exercise-induced cerebrovascular improvements in older, healthy adults.Item Open Access Operationalizing frailty among older residents of assisted living facilities(BioMed Central, 2011-05-13) Freiheit, Elizabeth A.; Hogan, David B.; Strain, Laurel A.; Schmaltz, Heidi N.; Patten, Scott B.; Eliasziw, Misha; Maxwell, Colleen J.Item Open Access A pragmatic study exploring the prevention of delirium among hospitalized older hip fracture patients: Applying evidence to routine clinical practice using clinical decision support(BioMed Central, 2010-10-22) Holroyd-Leduc, Jayna M.; Abelseth, Greg A.; Khandwala, Farah; Silvius, James L.; Hogan, David B.; Schmaltz, Heidi N.; Frank, Cyril B.; Straus, Sharon EItem Open Access Prevalence and correlates of anxiety and depression in caregivers to assisted living residents during COVID-19: a cross-sectional study(2022-08-12) Lane, Natasha E.; Hoben, Matthias; Amuah, Joseph E.; Hogan, David B.; Baumbusch, Jennifer; Gruneir, Andrea; Chamberlain, Stephanie A.; Griffith, Lauren E.; McGrail, Kimberlyn M.; Corbett, Kyle; Maxwell, Colleen J.Abstract Background Family and friend caregivers play significant roles in advocating for and ensuring quality health and social care of residents in Assisted Living (AL) homes. However, little is known about how the COVID-19 pandemic and related visitor restrictions affected their health and mental well-being. We examined the prevalence and correlates of anxiety and depressive symptoms among caregivers of AL residents during the initial wave of COVID-19 in two Canadian provinces. Methods A cross-sectional web-based survey was conducted among family/friend caregivers of AL residents in Alberta and British Columbia (Oct 28, 2020—Mar 31, 2021) to collect data on their sociodemographic, health and caregiving characteristics, as well as concerns about residents’ health and social care before and during the first wave of the pandemic. A clinically significant anxiety disorder and depressive symptoms were assessed with the GAD-7 and CES-D10 instruments, respectively. Separate multivariable (modified) Poisson regression models identified caregiver correlates of each mental health condition. Results Among the 673 caregivers completing the survey (81% for Alberta residents), most were women (77%), white (90%) and aged ≥ 55 years (81%). Clinically significant anxiety and depression were present in 28.6% and 38.8% of caregivers respectively. Both personal stressors (comorbidity level, income reduction, low social support) and caregiving stressors exacerbated by the pandemic were independently associated with caregiver anxiety and depression. The latter included increased concern about the care recipients’ depression (adjusted risk ratio [adjRR] = 1.84, 95% confidence interval [CI] 1.19–2.85 for caregiver anxiety and adjRR = 1.75, 95% CI 1.26–2.44 for caregiver depressive symptoms) and reported intention to withdraw the resident from AL because of COVID-19 (adjRR = 1.24, 95%CI 0.95–1.63 for caregiver anxiety and adjRR = 1.37, 95%CI 1.13–1.67 for caregiver depressive symptoms). Conclusions Caregivers of residents in AL homes reported significant personal and caregiving-related stressors during the initial wave of COVID-19 that were independently associated with an increased likelihood of experiencing clinically significant anxiety and depressive symptoms. Healthcare providers and AL staff should be aware of the prevalence and varied correlates of caregivers’ mental health during public health crises so that appropriate screening and support may identified and implemented.Item Open Access Social participation of older people in urban and rural areas: Canadian Longitudinal Study on Aging(2023-07-18) Jones, C. A.; Jhangri, Gian S.; Yamamoto, Shelby S.; Hogan, David B.; Hanson, Heather; Levasseur, Mélanie; Morales, Ernesto; Légaré, FranceAbstract Background and objectives Although the positive influence of social activity on health is now well-established, a complex relationship exists among social participation, personal, social and the environment. Social participation of older adults was examined in rural and urban settings to identify features of the built-environment and perception of neighborhood specific to the locale. Research Design and methods Using cross-sectional data from the Canadian Longitudinal Study on Aging (CLSA), we examined social participation and health of older people (65 + yrs) in relation to the built environment and sociocultural contexts for urban and rural areas. A social participation index was derived from responses on the frequency of participating in 8 social activities over the past 12 months. Personal, household and neighborhood indicators were examined to develop multivariable regression models for social participation in urban and rural cohorts. Results No meaningful differences were seen with the frequency of social participation between rural and urban settings; however, the type of community-related activities differed in that a greater proportion of urban participants reported sports and educational/cultural events than rural participants. Service club activities were greater for rural than urban participants. Different neighborhood features were statistically significant factors in explaining social participation in rural than in urban locales, although transportation was a significant factor regardless of locale. Trustworthiness, belonging and safety were perceived factors of the neighborhood associated with higher social participation for rural participants. Discussion and implications The relationship between home and health becomes stronger as one ages. Social and physical features of built environment specific to urban and rural settings need to be considered when implementing appropriate social activities for older people.Item Open Access Systematic Reviews and Meta-Analyses of the Incidence and Prevalence of Dementia and Its Commoner Neurodegenerative Causes(CAMBRIDGE UNIV PRESS, 2016) Jette, Nathalie; Maxwell, Colleen J.; Fiest, Kirsten M.; Hogan, David B.Item Open Access The Brain in Motion II Study: study protocol for a randomized controlled trial of an aerobic exercise intervention for older adults at increased risk of dementia(2021-06-14) Krüger, Renata L.; Clark, Cameron M.; Dyck, Adrienna M.; Anderson, Todd J.; Clement, Fiona; Hanly, Patrick J.; Hanson, Heather M.; Hill, Michael D.; Hogan, David B.; Holroyd-Leduc, Jayna; Longman, R. S.; McDonough, Meghan; Pike, G. B.; Rawling, Jean M.; Sajobi, Tolulope; Poulin, Marc J.Abstract Background There remains no effective intervention capable of reversing most cases of dementia. Current research is focused on prevention by addressing risk factors that are shared between cardiovascular disease and dementia (e.g., hypertension) before the cognitive, functional, and behavioural symptoms of dementia manifest. A promising preventive treatment is exercise. This study describes the methods of a randomized controlled trial (RCT) that assesses the effects of aerobic exercise and behavioural support interventions in older adults at increased risk of dementia due to genetic and/or cardiovascular risk factors. The specific aims are to determine the effect of aerobic exercise on cognitive performance, explore the biological mechanisms that influence cognitive performance after exercise training, and determine if changes in cerebrovascular physiology and function persist 1 year after a 6-month aerobic exercise intervention followed by a 1-year behavioural support programme (at 18 months). Methods We will recruit 264 participants (aged 50–80 years) at elevated risk of dementia. Participants will be randomly allocated into one of four treatment arms: (1) aerobic exercise and health behaviour support, (2) aerobic exercise and no health behaviour support, (3) stretching-toning and health behaviour support, and (4) stretching-toning and no health behaviour support. The aerobic exercise intervention will consist of three supervised walking/jogging sessions per week for 6 months, whereas the stretching-toning control intervention will consist of three supervised stretching-toning sessions per week also for 6 months. Following the exercise interventions, participants will receive either 1 year of ongoing telephone behavioural support or no telephone support. The primary aim is to determine the independent effect of aerobic exercise on a cognitive composite score in participants allocated to this intervention compared to participants allocated to the stretching-toning group. The secondary aims are to examine the effects of aerobic exercise on a number of secondary outcomes and determine whether aerobic exercise-related changes persist after a 1-year behavioural support programme (at 18 months). Discussion This study will address knowledge gaps regarding the underlying mechanisms of the pro-cognitive effects of exercise by examining the potential mediating factors, including cerebrovascular/physiological, neuroimaging, sleep, and genetic factors that will provide novel biologic evidence on how aerobic exercise can prevent declines in cognition with ageing. Trial registration ClinicalTrials.gov NCT03035851 . Registered on 30 January 2017Item Open Access The Prevalence and Incidence of Dementia Due to Alzheimer's Disease: a Systematic Review and Meta-Analysis(CAMBRIDGE UNIV PRESS, 2016) Fiest, Kirsten M.; Roberts, Jodie I.; Maxwell, Colleen J.; Hogan, David B.; Smith, Eric E.; Frolkis, Alexandra; Cohen, Adrienne; Kirk, Andrew; Pearson, Dawn; Pringsheim, Tamara; Venegas-Torres, Andres; Jette, NathalieBackground: Updated information on the epidemiology of dementia due to Alzheimer's disease (AD) is needed to ensure that adequate resources are available to meet current and future healthcare needs. We conducted a systematic review and meta-analysis of the incidence and prevalence of AD. Methods: The MEDLINE and EMBASE databases were searched from 1985 to 2012, as well as the reference lists of selected articles. Included articles had to provide an original population-based estimate for the incidence and/or prevalence of AD. Two individuals independently performed abstract and full-text reviews, data extraction and quality assessments. Random-effects models were employed to generate pooled estimates stratified by age, sex, diagnostic criteria, location (i.e., continent) and time (i.e., when the study was done). Results: Of 16,066 abstracts screened, 707 articles were selected for full-text review. A total of 119 studies met the inclusion criteria. In community settings, the overall point prevalence of dementia due to AD among individuals 60 + was 40.2 per 1000 persons (CI95%: 29.1-55.6), and pooled annual period prevalence was 30.4 per 1000 persons (CI95%: 15.6-59.1). In community settings, the overall pooled annual incidence proportion of dementia due to AD among individuals 60 + was 34.1 per 1000 persons (CI95%: 16.4-70.9), and the incidence rate was 15.8 per 1000 person-years (CI95%: 12.9-19.4). Estimates varied significantly with age, diagnostic criteria used and location (i.e., continent). Conclusions: The burden of AD dementia is substantial. Significant gaps in our understanding of its epidemiology were identified, even in a high-income country such as Canada. Future studies should assess the impact of using such newer clinical diagnostic criteria for AD dementia such as those of the National Institute on Aging-Alzheimer's Association and/or incorporate validated biomarkers to confirm the presence of Alzheimer pathology to produce more precise estimates of the global burden of AD.Item Open Access The Prevalence and Incidence of Dementia: a Systematic Review and Meta-analysis(CAMBRIDGE UNIV PRESS, 2016) Fiest, Kirsten M.; Jette, Nathalie; Roberts, Jodie I.; Maxwell, Colleen J.; Smith, Eric E.; Black, Sandra E.; Blaikie, Laura; Cohen, Adrienne; Day, Lundy; Holroyd-Leduc, Jayna; Kirk, Andrew; Pearson, Dawn; Pringsheim, Tamara; Venegas-Torres, Andres; Hogan, David B.Introduction: Dementia is a common neurological condition affecting many older individuals that leads to a loss of independence, diminished quality of life, premature mortality, caregiver burden and high levels of healthcare utilization and cost. This is an updated systematic review and meta-analysis of the worldwide prevalence and incidence of dementia. Methods: The MEDLINE and EMBASE databases were searched for relevant studies published between 2000 (1985 for Canadian papers) and July of 2012. Papers selected for full-text review were included in the systematic review if they provided an original population-based estimate for the incidence and/or prevalence of dementia. The reference lists of included articles were also searched for additional studies. Two individuals independently performed abstract and full-text review, data extraction, and quality assessment of the papers. Random-effects models and/or meta-regression were used to generate pooled estimates by age, sex, setting (i.e., community, institution, both), diagnostic criteria utilized, location (i.e., continent) and year of data collection. Results: Of 16,066 abstracts screened, 707 articles were selected for full-text review. A total of 160 studies met the inclusion criteria. Among individuals 60 and over residing in the community, the pooled point and annual period prevalence estimates of dementia were 48.62 (CI95%: 41.98-56.32) and 69.07 (CI95%: 52.36-91.11) per 1000 persons, respectively. The respective pooled incidence rate (same age and setting) was 17.18 (CI95%: 13.90-21.23) per 1000 person-years, while the annual incidence proportion was 52.85 (CI95%: 33.08-84.42) per 1,000 persons. Increasing participant age was associated with a higher dementia prevalence and incidence. Annual period prevalence was higher in North America than in South America, Europe and Asia (in order of decreasing period prevalence) and higher in institutional compared to community and combined settings. Sex, diagnostic criteria (except for incidence proportion) and year of data collection were not associated with statistically significant different estimates of prevalence or incidence, though estimates were consistently higher for females than males. Conclusions: Dementia is a common neurological condition in older individuals. Significant gaps in knowledge about its epidemiology were identified, particularly with regard to the incidence of dementia in low- and middle-income countries. Accurate estimates of prevalence and incidence of dementia are needed to plan for the health and social services that will be required to deal with an aging population.Item Open Access The Prevalence and Incidence of Frontotemporal Dementia: a Systematic Review(CAMBRIDGE UNIV PRESS, 2016) Hogan, David B.; Jette, Nathalie; Fiest, Kirsten M.; Roberts, Jodie I.; Pearson, Dawn; Smith, Eric E.; Pamela Roach; Kirk, Andrew; Pringsheim, Tamara; Maxwell, Colleen J.Background Population-based prevalence and incidence studies are essential for understanding the burden of frontotemporal dementia (FTD). Methods The MEDLINE and EMBASE databases were searched to identify population-based publications from 1985 to 2012, addressing the incidence and/or prevalence of FTD. References of included articles and prior systematic reviews were searched for additional studies. Two reviewers screened all abstracts and full-text reviews, abstracted data and performed quality assessments. Results Twenty-six studies were included. Methodological limitations led to wide ranges in the estimates for prevalence (point prevalence 0.01-4.6 per 1000 persons; period prevalence 0.16-31.04 per 1000 persons) and incidence (0.0-0.3 per 1000 person-years). FTD accounted for an average of 2.7% (range 0-9.1%) of all dementia cases among prevalence studies that included subjects 65 and older compared to 10.2% (range 2.8-15.7%) in studies restricted to those aged less than 65. The cumulative numbers of male (373 [52.5%]) and female (338 [47.5%]) cases from studies reporting this information were nearly equal (p=0.18). The behavioural variant FTD (bvFTD) was almost four times as common as the primary progressive aphasias. Conclusions Population-based estimates for the epidemiology of FTD varied widely in the included studies. Refinements in the diagnostic process, possibly by the use of validated biomarkers or limiting case ascertainment to specialty services, are needed to obtain more precise estimates of the prevalence and incidence of FTD.Item Open Access Waiting for a space in an adult day support program: retrospective caregiver perspectives(2004) Hildebrandt, Clare Rachel; Hogan, David B.Adult Day Support Programs (ADSPs) are designed to give caregivers of individuals with dementia respite; however, there is little empirical evidence into the burden borne by caregivers who wait for community based health services. A cross-sectional, retrospective questionnaire was used to assess the levels of burden, stress, depression, self esteem and the perceived impact of waiting for an ADSP of caregivers of individuals who attended dementia-specific ADSPs in the Calgary Health Region. The response rate for perceived, expected, and acceptable waiting times was insufficient to draw conclusions; however, thirty percent of caregivers found that the waiting period allowed them to adapt to the use of ADSPs, compared with twenty-five percent who found that waiting for ADSP services was associated with an increase in stress level. Waiting time did not have an association with current caregiver burden. These results support further investigation into the effects of waiting for community based health services.Item Open Access Waiting for space in an adult day support program: Retrospective caregiver perspectives(2004) Hildebrandt, Clare Rachel; Hogan, David B.