Annals of Indian Academy of Neurology
: 2016  |  Volume : 19  |  Issue : 3  |  Page : 417-

Choosing controls

Sunil Kumar Raina 
 Department of Community Medicine, DR. RPGMC, Tanda, Kangra, Himachal Pradesh, India

Correspondence Address:
Sunil Kumar Raina
Department of Community Medicine, DR. RPGMC, Tanda, Kangra, Himachal Pradesh

How to cite this article:
Raina SK. Choosing controls.Ann Indian Acad Neurol 2016;19:417-417

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Raina SK. Choosing controls. Ann Indian Acad Neurol [serial online] 2016 [cited 2021 Sep 22 ];19:417-417
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Went through with interest article entitled "Perceived caregiver stress in Alzheimer's disease and mild cognitive impairment: A case-control study" published in Ann Indian Acad Neurol (2016;19:58-62). [1] The authors deserve credit for highlighting an important area of concern in patient management.

However, I have a concern. The authors conducted the present study in a case-control study design mode with caregivers of patients diagnosed with Alzheimer's disease/mild cognitive impairment (AD/MCI) identified as cases while the controls included caregivers of patients with chronic medical and psychiatric disorders. [1] Accordingly, a total of 31 patients of AD/MCI (males = 24, females = 7), and 30 controls (males = 18, females = 12) were interviewed. On the basis of this, the authors conclude that caregivers of patients with AD/MCI have a high perceived stress compared to caregivers of patients with other chronic illness. Now, this is where my primary concern lies. Agreed that the study being a hospital-based case-control study and choosing suitable hospital controls is often difficult, but choosing the right controls is perhaps the most important step in a case-control study. [2] Herein, the authors have chosen controls which may not be similar to cases in variables (other than the variable of interest), which is a fundamental principle of case-control studies. This is clearly apparent in [Table 1] of the study (reproduced below). The mean age for caregivers of AD/MCI (cases) was 69 ± 11.86 years while for caregivers of chronic disorders it was much less at 56 ± 5.53 years. Similarly, the mean duration of illness was higher in AD/MCI as compared to caregivers of chronic disorders (controls). Other parameters which influence perceived stress including gender and social status has not been dealt with by the authors.{Table 1}

Further, it is known fact that caregivers of individuals with dementia suffer from caregiver burden more frequently than other caregiver groups and are more vulnerable for various health problems. [3] Therefore, matching for factors associated with caregiver burden such as the sociodemographic status of the caregiver and care recipient, the nature of the disease of the care-recipient, etc., assumes importance.

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1Anand KS, Dhikav V, Sachdeva A, Mishra P. Perceived caregiver stress in Alzheimer's disease and mild cognitive impairment: A case control study. Ann Indian Acad Neurol 2016;19:58-62.
2Raina SK. Age and sex matching in case-control studies. Lung India 2015;32:544.
3Kim H, Chang M, Rose K, Kim S. Predictors of caregiver burden in caregivers of individuals with dementia. J Adv Nurs 2012;68:846-55.