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Wasick A, Kim Y. Association between the Composition of Drinking Water and Cognitive Function in the Elderly: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:362. [PMID: 38541362 PMCID: PMC10969896 DOI: 10.3390/ijerph21030362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 03/06/2024] [Accepted: 03/15/2024] [Indexed: 04/05/2024]
Abstract
The prevalence of dementia increases with nearly 10 million new cases each year, with Alzheimer's disease contributing to 60-70% of cases. Environmental factors such as drinking water have been evaluated to determine if a relationship exists between trace elements in drinking water and the risk of developing cognitive disorders in the elderly. The purpose of the current systematic review was to evaluate an association between the composition of drinking water and cognitive function in the elderly. In accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines, a literature search was conducted using PubMed and CINAHL databases. A total of 10 studies were included in the current systematic review. Aluminum is the most commonly evaluated trace element in studies (n = 8), followed by silica (n = 5), calcium (n = 4), and fluoride (n = 4). Aluminum exposure showed an increased risk of cognitive decline in four studies, with no association reported in the other studies. Higher silica and pH levels were shown to be protective against a decline in cognitive function. A similar protective effect of calcium was found in two studies. Future research should measure multiple trace mineral levels in all water sources to evaluate the impact on cognitive function.
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Affiliation(s)
| | - Yeonsoo Kim
- Nutrition and Dietetics Program, Central Michigan University, 1200 South Franklin Street, Mt. Pleasant, MI 48859, USA;
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2
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Tay LX, Ong SC, Tay LJ, Ng T, Parumasivam T. Economic Burden of Alzheimer's Disease: A Systematic Review. Value Health Reg Issues 2024; 40:1-12. [PMID: 37972428 DOI: 10.1016/j.vhri.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/18/2023] [Accepted: 09/28/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES Alzheimer's disease (AD) has become one of the most prevalent neurodegenerative disorders among the elderly. The global cost of dementia is expected to reach US $2 trillion in 2030. In this systematic review, existing evidence on the cost of dementia specific to AD is appraised. METHODS A comprehensive search was done on 3 databases, namely PubMed, ScienceDirect, and Web of Science, to identify original cost-of-illness studies that only evaluate the economic burden of AD up to August 2022. The risk of bias in the studies was assessed using Consolidated Health Economic Evaluation Reporting Standards 2022 criteria. Cost articles without specifying etiology of AD or those in non-English were excluded. RESULTS Twelve of 5536 studies met the inclusion criteria. The total annual cost of AD per capita ranged from US $468.28 in mild AD to US $171 283.80 in severe AD. The cost of care raised nonlinearly with disease severity. Indirect caregiving cost represented the main contributor to societal cost in community-dwelling patients. When special caregiving accommodation was opted in daily care, it results in cost shifting from indirect cost to direct nonmedical cost. Formal caregiving accommodation caused increase in direct cost up to 67.3% of overall economic burden of the disease. CONCLUSIONS AD exerts a huge economic burden on patients and caregivers. Overall rise of each cost component could be anticipated with disease deterioration. Choice of special caregiving accommodation could reduce caregiver's productivity loss but increase the direct nonmedical expenditure of the disease from societal perspective.
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Affiliation(s)
- Lyn Xuan Tay
- Discipline of Social and Administrative Pharmacy, Universiti Sains Malaysia, Pulau Pinang, Gelugor, Malaysia
| | - Siew Chin Ong
- Discipline of Social and Administrative Pharmacy, Universiti Sains Malaysia, Pulau Pinang, Gelugor, Malaysia.
| | - Lynn Jia Tay
- School of International Education, An Hui Medical University, He Fei, An Hui, China
| | - Trecia Ng
- West China School of Medicine, Si Chuan University, Cheng Du, Si Chuan, China
| | - Thaigarajan Parumasivam
- Discipline of Pharmaceutical Technology, Universiti Sains Malaysia, Pulau Pinang, Gelugor, Malaysia
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3
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Otaka Y, Kitamura S, Suzuki M, Maeda A, Kato C, Ito R, Hirano A, Okochi Y, Mizutani K, Yoshino H, Takechi H. EFFECTS OF REHABILITATION PROGRAM FOCUSED ON IMPROVING REAL-LIFE DAILY ACTIVITIES OF PATIENTS WITH MILD COGNITIVE IMPAIRMENTS OR DEMENTIA AND THEIR CAREGIVERS. JOURNAL OF REHABILITATION MEDICINE. CLINICAL COMMUNICATIONS 2023; 6:12293. [PMID: 37829668 PMCID: PMC10566518 DOI: 10.2340/jrmcc.v6.12293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 10/14/2023]
Abstract
Objective To evaluate the effectiveness of a dyadic outpatient rehabilitation program focused on improving the real-life daily activities of patients with mild cognitive impairments or dementia and their caregivers. Design Retrospective study. Subjects Eight patients with mild cognitive impairments or dementia and their caregivers. Methods The rehabilitation program comprised eight 1-hour sessions by occupational therapists with patients and his/her caregivers. Patients were assessed for motor function, cognitive function, and quality of life, and their caregivers were assessed for depression and caregiver burden. Participants were assessed at pre-program and post-program, and 3-month follow-up. Results The scores of caregiver-assessed Quality of life in Alzheimer's disease scale in patients significantly improved at post-program (median [interquartile range], 30.0 [7.0]) compared with pre-program (27.0 [2.8], effect size = 0.77, p = 0.029). In caregivers, the Zarit Caregiver Burden Interview scores decreased significantly at post-program (16.5 [13.0]) compared with pre-program (22.0 [17.5], effect size = 0.72, p = 0.042). There were no significant differences in other assessments. Conclusions The rehabilitation program focused on real daily activities and demonstrated to improve patients' quality of life and caregivers' depression and caring burden through patient-caregiver interaction. Future enhanced follow-up systems are warranted.
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Affiliation(s)
- Yohei Otaka
- Department of Rehabilitation Medicine I, School of Medicine
| | - Shin Kitamura
- Department of Rehabilitation Medicine I, School of Medicine
- Faculty of Rehabilitation, School of Health Sciences
| | - Megumi Suzuki
- Faculty of Rehabilitation, School of Health Sciences
| | - Akiko Maeda
- Faculty of Rehabilitation, School of Health Sciences
| | - Chinami Kato
- Department of Rehabilitation, Fujita Health University Hospital, Aichi, Japan
| | - Rena Ito
- Department of Rehabilitation, Fujita Health University Hospital, Aichi, Japan
| | - Asuka Hirano
- Department of Rehabilitation, Fujita Health University Hospital, Aichi, Japan
| | - Yuki Okochi
- Department of Rehabilitation, Fujita Health University Hospital, Aichi, Japan
| | - Koji Mizutani
- Department of Rehabilitation, Fujita Health University Hospital, Aichi, Japan
| | - Hiroshi Yoshino
- Department of Geriatrics and Cognitive Disorders, School of Medicine, Fujita Health University, Aichi, Japan
| | - Hajime Takechi
- Department of Geriatrics and Cognitive Disorders, School of Medicine, Fujita Health University, Aichi, Japan
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4
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Su W, Xu W, Liu E, Su W, Polyakov NE. Improving the Treatment Effect of Carotenoids on Alzheimer's Disease through Various Nano-Delivery Systems. Int J Mol Sci 2023; 24:ijms24087652. [PMID: 37108814 PMCID: PMC10142927 DOI: 10.3390/ijms24087652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/10/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023] Open
Abstract
Natural bioactive compounds have recently emerged as a current strategy for Alzheimer's disease treatment. Carotenoids, including astaxanthin, lycopene, lutein, fucoxanthin, crocin and others are natural pigments and antioxidants, and can be used to treat a variety of diseases, including Alzheimer's disease. However, carotenoids, as oil-soluble substances with additional unsaturated groups, suffer from low solubility, poor stability and poor bioavailability. Therefore, the preparation of various nano-drug delivery systems from carotenoids is a current measure to achieve efficient application of carotenoids. Different carotenoid delivery systems can improve the solubility, stability, permeability and bioavailability of carotenoids to a certain extent to achieve Alzheimer's disease efficacy. This review summarizes recent data on different carotenoid nano-drug delivery systems for the treatment of Alzheimer's disease, including polymer, lipid, inorganic and hybrid nano-drug delivery systems. These drug delivery systems have been shown to have a beneficial therapeutic effect on Alzheimer's disease to a certain extent.
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Affiliation(s)
- Wenjing Su
- Collaborative Innovation Center of Yangtze River Delta Region Green Pharmaceuticals, Zhejiang University of Technology, Hangzhou 310014, China
| | - Wenhao Xu
- Collaborative Innovation Center of Yangtze River Delta Region Green Pharmaceuticals, Zhejiang University of Technology, Hangzhou 310014, China
| | - Enshuo Liu
- Collaborative Innovation Center of Yangtze River Delta Region Green Pharmaceuticals, Zhejiang University of Technology, Hangzhou 310014, China
| | - Weike Su
- Collaborative Innovation Center of Yangtze River Delta Region Green Pharmaceuticals, Zhejiang University of Technology, Hangzhou 310014, China
| | - Nikolay E Polyakov
- Institute of Solid State Chemistry and Mechanochemistry, 630128 Novosibirsk, Russia
- Institute of Chemical Kinetics and Combustion, 630090 Novosibirsk, Russia
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5
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Kruse C, Maier F, Spottke A, Bach JP, Bartels C, Buerger K, Fellgiebel A, Fliessbach K, Frölich L, Hausner L, Hellmich M, Klöppel S, Klostermann A, Kornhuber J, Laske C, Peters O, Priller J, Richter-Schmidinger T, Schneider A, Shah-Hosseini K, Teipel S, von Arnim CAF, Wiltfang J, van der Wurp H, Dodel R, Jessen F. Apathy in patients with Alzheimer's disease is a cost-driving factor. Alzheimers Dement 2023. [PMID: 36588502 DOI: 10.1002/alz.12915] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/30/2022] [Accepted: 09/02/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Apathy is the most frequent neuropsychiatric symptom in patients with dementia of the Alzheimer's type (DAT). We analyzed the influence of apathy on the resource use of DAT patients and their caregivers. METHODS Included were baseline data of 107 DAT patients from a randomized clinical trial on apathy treatment. The Resource Utilization in Dementia (RUD) instrument assessed costs over a 1-month period prior to baseline. Cost predictors were determined via a least absolute shrinkage and selection operator (LASSO). RESULTS On average, total monthly costs were €3070, of which €2711 accounted for caregivers' and €359 for patients' costs. An increase of one point in the Apathy Evaluation Scale resulted in a 4.1% increase in total costs. DISCUSSION Apathy is a significant cost driving factor for total costs in mild to moderate DAT. Effective treatment of apathy might be associated with reduced overall costs in DAT.
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Affiliation(s)
- Christopher Kruse
- Department of Geriatric Medicine, Center for Translational Neurological and Behavioural Research, University Duisburg-Essen, Duisburg, Germany
| | - Franziska Maier
- Department of Psychiatry, University Hospital Cologne, Medical Faculty, Cologne, Germany
| | - Annika Spottke
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.,Department of Neurology, University of Bonn, Bonn, Germany
| | - Jan-Philipp Bach
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Claudia Bartels
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen (UMG), Georg-August-University, Goettingen, Germany
| | - Katharina Buerger
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Andreas Fellgiebel
- Center for Mental Health in Old Age, Landeskrankenhaus (AöR), Mainz, Germany
| | - Klaus Fliessbach
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Lutz Frölich
- Department of Geriatric Psychiatry, Zentralinstitut für Seelische Gesundheit Mannheim, University of Heidelberg, Mannheim, Germany
| | - Lucrezia Hausner
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry, University of Bern, Bern, Switzerland
| | - Arne Klostermann
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany.,Department of Psychiatry, Charité Berlin, Berlin, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Christoph Laske
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany.,Section for Dementia Research, Hertie Institute for Clinical Brain Research and Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Oliver Peters
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany.,Department of Psychiatry, Charité Berlin, Berlin, Germany
| | - Josef Priller
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany.,Department of Neuropsychiatry, Charité Berlin & Berlin Institute of Health, Berlin, Germany
| | - Tanja Richter-Schmidinger
- Department of Psychiatry and Psychotherapy, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Anja Schneider
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.,Klinik für Neurodegenerative Erkrankungen und Gerontopsychiatrie, University of Bonn, Bonn, Germany
| | - Kija Shah-Hosseini
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany.,Department of Psychosomatic Medicine, University Hospital of Rostock, Rostock, Germany
| | | | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen (UMG), Georg-August-University, Goettingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Goettingen, Germany
| | - Hendrik van der Wurp
- Department of Geriatric Medicine, Center for Translational Neurological and Behavioural Research, University Duisburg-Essen, Duisburg, Germany.,Department of Statistics, TU Dortmund University, Dortmund, Germany
| | - Richard Dodel
- Department of Geriatric Medicine, Center for Translational Neurological and Behavioural Research, University Duisburg-Essen, Duisburg, Germany.,Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Frank Jessen
- Department of Psychiatry, University Hospital Cologne, Medical Faculty, Cologne, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.,Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
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6
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Jönsson L, Tate A, Frisell O, Wimo A. The Costs of Dementia in Europe: An Updated Review and Meta-analysis. PHARMACOECONOMICS 2023; 41:59-75. [PMID: 36376775 PMCID: PMC9813179 DOI: 10.1007/s40273-022-01212-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND AND OBJECTIVE The prevalence of dementia is increasing, while new opportunities for diagnosing, treating and possibly preventing Alzheimer's disease and other dementia disorders are placing focus on the need for accurate estimates of costs in dementia. Considerable methodological heterogeneity creates challenges for synthesising the existing literature. This study aimed to estimate the costs for persons with dementia in Europe, disaggregated into cost components and informative patient subgroups. METHODS We conducted an updated literature review searching PubMed, Embase and Web of Science for studies published from 2008 to July 2021 reporting empirically based cost estimates for persons with dementia in European countries. We excluded highly selective or otherwise biased reports, and used a random-effects meta-analysis to produce estimates of mean costs of care across five European regions. RESULTS Based on 113 studies from 17 European countries, the estimated mean costs for all patients by region were highest in the British Isles (73,712 EUR), followed by the Nordics (43,767 EUR), Southern (35,866 EUR), Western (38,249 EUR), and Eastern Europe and Baltics (7938 EUR). Costs increased with disease severity, and the distribution of costs over informal and formal care followed a North-South gradient with Southern Europe being most reliant on informal care. CONCLUSIONS To our knowledge, this study represents the most extensive meta-analysis of the cost for persons with dementia in Europe to date. Though there is considerable heterogeneity across studies, much of this is explained by identifiable factors. Further standardisation of methodology for capturing resource utilisation data may further improve comparability of future studies. The cost estimates presented here may be of value for cost-of-illness studies and economic evaluations of novel diagnostic technologies and therapies for Alzheimer's disease.
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Affiliation(s)
- Linus Jönsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden.
| | - Ashley Tate
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | - Oskar Frisell
- Institute of Health Economics (IHE), Stockholm, Sweden
| | - Anders Wimo
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
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7
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Profyri E, Leung P, Huntley J, Orgeta V. Effectiveness of treatments for people living with severe dementia: A systematic review and meta-analysis of randomised controlled clinical trials. Ageing Res Rev 2022; 82:101758. [PMID: 36243355 PMCID: PMC10580243 DOI: 10.1016/j.arr.2022.101758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/30/2022] [Accepted: 10/09/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Dementia is a progressive neurodegenerative syndrome that has no cure. Although a significant proportion of people with dementia progress into the severe stages of the disease, evidence on the clinical effectiveness of treatments for people with severe dementia remains limited. AIMS To systematically review the effectiveness of pharmacological and non-pharmacological treatments for people living with severe dementia and assess the quality of the evidence. METHOD We searched MEDLINE, EMBASE, PsycINFO, CINAHL and online clinical trial registers up to January 2022, for Randomised Controlled Trials (RCT) in people living with severe dementia. Quality and risk of bias were assessed independently by two authors. RESULTS A total of 30 trials met our inclusion criteria of which 14 evaluated the effectiveness of pharmacological treatments, and 16 evaluated a non-pharmacological intervention. Pharmacological treatments: Meta-analyses indicated that pharmacological treatments (donepezil: 10 mg, 5 mg; galantamine: 24 mg; memantine: 10 mg) are associated with better outcomes compared to placebo for: severity of symptoms (standardized mean difference (SMD) 0.37, 95% CI 0.26-0.48; 4 studies; moderate-certainty evidence), activities of daily living (SMD 0.15, 95% CI 0.04-0.26; 5 studies; moderate-certainty evidence), and clinical impression of change (Relative Risk (RR) 1.34, 95% CI 1.14-1.57; 4 studies; low-certainty evidence). Pharmacological treatments were also more likely to reduce mortality compared to placebo (RR 0.60, 95% CI 0.40-0.89; 6 studies; low-certainty evidence). Non-pharmacological treatments: Five trials were included in the meta-analyses of non-pharmacological interventions (multi-sensory stimulation, needs assessment, and activities-based interventions); results showed that non-pharmacological interventions may reduce neuropsychiatric symptoms of dementia compared to usual care (SMD -0.33, 95% CI -0.59 to -0.06; low certainty evidence). CONCLUSIONS There is moderate-certainty evidence that pharmacological treatments may decrease disease severity and improve function for people with severe dementia. Non-pharmacological treatments are probably effective in reducing neuropsychiatric symptoms but the quality of evidence remains low. There is an urgent need for high-quality evidence for other outcomes and for developing service-user informed interventions for this under-served group.
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8
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Persson S, Saha S, Gerdtham UG, Toresson H, Trépel D, Jarl J. Healthcare costs of dementia diseases before, during and after diagnosis: Longitudinal analysis of 17 years of Swedish register data. Alzheimers Dement 2022; 18:2560-2569. [PMID: 35189039 PMCID: PMC10078636 DOI: 10.1002/alz.12619] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 08/27/2021] [Accepted: 12/10/2021] [Indexed: 01/31/2023]
Abstract
INTRODUCTION This study examines health-care costs attributed to dementia diseases in the 10 years prior to, during, and 6 years after diagnosis. METHODS Using administrative register data for people diagnosed with dementia (2010-2016) in southern Sweden (n = 21,184), and a comparison group without dementia, health-care costs over 17 years were examined using longitudinal regression analysis. RESULTS Average annual health-care costs per person were consistently higher before diagnosis in the dementia group (10 years before: Swedish krona (SEK) 2063, P < .005 and 1 year before: SEK8166, P < .005). At diagnosis, health-care costs were more than twice as high (SEK44,410, P < .005). Four to 6 years after diagnosis, there was no significant different in costs compared to comparators. DISCUSSION Excess health-care cost arise as early as 10 years before a formal diagnosis of dementia, and while there is a spike in cost after diagnosis, health-care costs are no different 4 years after. These findings question currently accepted assumptions on costs of dementia.
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Affiliation(s)
- Sofie Persson
- Health Economics Unit, Department of Clinical Science (Malmö), Lund University, Lund, Sweden
| | - Sanjib Saha
- Health Economics Unit, Department of Clinical Science (Malmö), Lund University, Lund, Sweden.,Global Brain Health Institute ,Trinity College Dublin, Dublin, Ireland, University California, San Francisco, San Francisco, California, USA
| | - Ulf-G Gerdtham
- Health Economics Unit, Department of Clinical Science (Malmö), Lund University, Lund, Sweden.,Centre for Economic Demography, Lund University, Lund, Sweden.,Department of Economics, Lund University, Lund, Sweden
| | - Håkan Toresson
- Clinical Memory Research Unit, Department of Clinical Science (Malmö), Lund University, Lund, Sweden
| | - Dominic Trépel
- Global Brain Health Institute ,Trinity College Dublin, Dublin, Ireland, University California, San Francisco, San Francisco, California, USA.,Trinity College, Trinity Institute of Neurosciences (TCIN), Dublin, Ireland
| | - Johan Jarl
- Health Economics Unit, Department of Clinical Science (Malmö), Lund University, Lund, Sweden
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Muñoz-Bermejo L, González-Becerra MJ, Barrios-Fernández S, Postigo-Mota S, Jerez-Barroso MDR, Martínez JAF, Suárez-Lantarón B, Marín DM, Martín-Bermúdez N, Ortés-Gómez R, Gómez-Ullate-García de León M, Martínez-Acevedo M, Rocha-Gómez L, Espejo-Antúnez S, Fraile-Bravo M, Galán MGS, Chato-Gonzalo I, Muñoz FJD, Hernández-Mocholí MÁ, Madruga-Vicente M, Prado-Solano A, Mendoza-Muñoz M, Carlos-Vivas J, Pérez-Gómez J, Pastor-Cisneros R, Fuentes-Flores P, Pereira-Payo D, De Los Ríos-Calonge J, Urbano-Mairena J, Guerra-Bustamante J, Adsuar JC. Cost-Effectiveness of the Comprehensive Interdisciplinary Program-Care in Informal Caregivers of People with Alzheimer's Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192215243. [PMID: 36429962 PMCID: PMC9691117 DOI: 10.3390/ijerph192215243] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/11/2022] [Accepted: 11/16/2022] [Indexed: 05/27/2023]
Abstract
People with Alzheimer's disease (AD) diagnosis who get informal care remain at home longer, reducing the demand for healthcare resources but increasing the stress of caregiving. Research on the effectiveness of physical training, psychoeducational, cognitive-behavioural, and health education programs in reducing the caregiver load and enhancing health-related quality of life (HRQoL) exist, but none exist about an integrated interdisciplinary program. The goals of this project are (1) to assess the Integral-CARE Interdisciplinary Program (IP) applicability, safety, effects on HRQoL, and the incremental cost-effectiveness ratio for AD caregivers; (2) to evaluate the IP applicability and cost-effectiveness to enhance the physical, psychoemotional, cognitive-behavioural dimensions, and the health education status of informal caregivers, and (3) to study the transference of the results to the public and private sectors. A randomized controlled trial will be conducted with an experimental (IP) and a control group (no intervention). The PI will be conducted over nine months using face-to-face sessions (twice a week) and virtual sessions on an online platform (once a week). There will be an initial, interim (every three months), and final assessment. Focus groups with social and health agents will be organized to determine the most important information to convey to the public and private sectors in Extremadura (Spain). Applicability, safety, HRQoL, incremental cost-effectiveness ratio, and HRQoL will be the main outcome measures, while secondary measures will include sociodemographic data; physical, psychoemotional, health education, and cognitive-behavioural domains; program adherence; and patient health status. Data will be examined per procedure and intention to treat. A cost-effectiveness study will also be performed from the viewpoints of private and public healthcare resources.
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Affiliation(s)
- Laura Muñoz-Bermejo
- Social Impact and Innovation in Health (InHEALTH) Research Group, University Centre of Mérida, University of Extremadura, 06800 Mérida, Spain
| | | | - Sabina Barrios-Fernández
- Social Impact and Innovation in Health (InHEALTH) Research Group, University Centre of Mérida, University of Extremadura, 06800 Mérida, Spain
| | - Salvador Postigo-Mota
- Department of Nursing, Faculty of Medicine, University of Extremadura, 06006 Badajoz, Spain
| | - María del Rocío Jerez-Barroso
- Social Impact and Innovation in Health (InHEALTH) Research Group, University Centre of Mérida, University of Extremadura, 06800 Mérida, Spain
| | - Juan Agustín Franco Martínez
- Health Economy Motricity and Education (HEME) Research Group, Faculty of Sport Science, University of Extremadura, 10003 Cáceres, Spain
| | - Belén Suárez-Lantarón
- Education Sciences Department, Faculty of Education, University of Extremadura, 06006 Badajoz, Spain
| | - Diego Muñoz Marín
- Department of Musical, Plastic and Corporal Expression, Faculty of Sport Sciences, University of Extremadura, Av. de la Universidad, s/n, 10003 Cáceres, Spain
| | - Nieves Martín-Bermúdez
- Department of Educational Sciences, Faculty of Education and Education and Psychology, University of Extremadura, 10003 Cáceres, Spain
| | - Raquel Ortés-Gómez
- Area Specialist in the Extremadura Health Service, Geriatrics Service of the Hospital Virgen del Puerto de Plasencia, 10600 Plasencia, Spain
| | - Martín Gómez-Ullate-García de León
- Department of Teaching of Musical, Plastic and Body Expression, Faculty of Teacher Training, University of Extremadura, 10004 Cáceres, Spain
| | | | - Lara Rocha-Gómez
- Gpex-Eshaex Superior School of Hotel Management and Agrotourism of Extremadura, 06800 Mérida, Spain
| | - Sara Espejo-Antúnez
- Department of Educational Sciences, Faculty of Teacher Training, University of Extremadura, 10004 Cáceres, Spain
| | - Mercedes Fraile-Bravo
- Health Economy Motricity and Education (HEME) Research Group, Faculty of Sport Science, University of Extremadura, 10003 Cáceres, Spain
| | - María Gloria Solís Galán
- Department of Educational Sciences, Faculty of Teacher Training, University of Extremadura, 10004 Cáceres, Spain
| | - Ignacio Chato-Gonzalo
- Department of Social Sciences, Language and Literature Teaching, Faculty of Teacher Training, University of Extremadura, 10004 Cáceres, Spain
| | - Francisco Javier Domínguez Muñoz
- Physical Activity and Quality of Life (AFYCAV) Research Group, Faculty of Sport Science, University of Extremadura, 10003 Cáceres, Spain
| | - Miguel Ángel Hernández-Mocholí
- Physical Activity and Quality of Life (AFYCAV) Research Group, Faculty of Sport Science, University of Extremadura, 10003 Cáceres, Spain
| | - Miguel Madruga-Vicente
- Physical Activity and Quality of Life (AFYCAV) Research Group, Faculty of Sport Science, University of Extremadura, 10003 Cáceres, Spain
| | - Angelina Prado-Solano
- Social Impact and Innovation in Health (InHEALTH) Research Group, University Centre of Mérida, University of Extremadura, 06800 Mérida, Spain
| | - María Mendoza-Muñoz
- Physical and Health Literacy and Health-Related Quality of Life (PHYQOL) Research Group, Faculty of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain
| | - Jorge Carlos-Vivas
- Health Economy Motricity and Education (HEME) Research Group, Faculty of Sport Science, University of Extremadura, 10003 Cáceres, Spain
| | - Jorge Pérez-Gómez
- Health Economy Motricity and Education (HEME) Research Group, Faculty of Sport Science, University of Extremadura, 10003 Cáceres, Spain
| | - Raquel Pastor-Cisneros
- Social Impact and Innovation in Health (InHEALTH) Research Group, University Centre of Mérida, University of Extremadura, 06800 Mérida, Spain
| | - Paulina Fuentes-Flores
- Promoting a Healthy Society (PHeSo) Research Group, Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain
| | - Damián Pereira-Payo
- Promoting a Healthy Society (PHeSo) Research Group, Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain
| | - Javier De Los Ríos-Calonge
- Promoting a Healthy Society (PHeSo) Research Group, Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain
| | - Javier Urbano-Mairena
- Promoting a Healthy Society (PHeSo) Research Group, Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain
| | - Joan Guerra-Bustamante
- Health Economy Motricity and Education (HEME) Research Group, Faculty of Sport Science, University of Extremadura, 10003 Cáceres, Spain
| | - José Carmelo Adsuar
- Promoting a Healthy Society (PHeSo) Research Group, Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain
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10
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Vetrano DL, Grande G, Mazzoleni F, Lovato V, Cricelli C, Lapi F. Primary care costs due to prodromal Alzheimer disease: a real-world study in patients with a 10-year or longer medical history. Curr Med Res Opin 2022; 38:743-747. [PMID: 35380092 DOI: 10.1080/03007995.2022.2062179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The aim of this study was to estimate primary care costs of prodromal signs/symptoms of Alzheimer disease (AD), during a 10-year or longer period preceding AD diagnosis, in relation to costs cumulated in the general population for the same reasons. METHODS Nested case-control study involving 1889 AD cases and 18,890 controls aged 60+ from the Italian primary care Health Search Database (HSD). AD incident cases were through the International Classification of Diseases, 9th edition. Costs related to drugs, diagnostic tests and specialist referrals triggered by prodromal AD signs and/or symptoms were quantified and compared with costs cumulated by non-AD counterparts. RESULTS During the pre-diagnosis 10-year or longer period, prodromal signs and symptoms trigger diagnostic and therapeutic costs 55% higher than those cumulated in general population for the same clinical reasons. After accounting for patients' comorbidity and regional differences, the mean cost related to diagnostic and therapeutic procedures, and those related to specialist referrals, amounted to 854.1 €(SD: 630.6 €) in AD incident cases vs. 527.3 €(SD: 446.2) cumulated in patients not developing AD. CONCLUSION Prodromal AD manifestations are associated with primary care costs that resulted higher than those cumulated in the general population aged 60+. It remains to be elucidated if earlier dementia diagnoses would be associated with reduced costs triggered by the same clinical signs and symptoms.
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Affiliation(s)
- Davide L Vetrano
- Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Giulia Grande
- Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | | | | | - Claudio Cricelli
- Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Francesco Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
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11
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Dauphinot V, Potashman M, Levitchi-Benea M, Su R, Rubino I, Krolak-Salmon P. Economic and caregiver impact of Alzheimer's disease across the disease spectrum: a cohort study. Alzheimers Res Ther 2022; 14:34. [PMID: 35151368 PMCID: PMC8841058 DOI: 10.1186/s13195-022-00969-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 01/30/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Alzheimer's disease (AD) substantially increases health-related costs. This study investigates direct medical costs and characterizes the caregiver burden across AD stages. METHODS This study analyzed data from the French Primary Health Insurance Fund claims database and reflected this public payer perspective. Outpatients (N = 1998) visiting a memory clinic at Lyon University Hospital in France between 2014 and 2019 were included. Real healthcare costs (ie, ambulatory medicine, paramedical care, pharmaceutical treatment, public and private hospital stays, and medical transportation) were collected for patients 1 year prior to the date of the first memory visit and 2 years following the first visit (reference year: 2019). Patients were grouped based on a clinical diagnosis of cognitively normal with a subjective cognitive complaint (SCC), all-cause mild cognitive impairment (MCI), or AD dementia. The severity of AD dementia was defined by the Mini-Mental State Examination score. Caregiver burden was measured using the mini Zarit Burden Interview. A generalized linear model was used for statistical analyses. Other patient nonmedical and indirect costs and caregiver costs were not included. RESULTS The study sample included patients with SCC (n = 640), MCI (n = 630), mild (n = 212), moderate (n = 256), or moderately severe/severe AD dementia (n = 260). One year after the first consultation, mean total costs were higher with progressive cognitive deficit, with little difference between dementia groups (SCC = €8028; MCI = €9758; mild AD dementia = €10,558; moderate AD dementia = €10,544; moderately severe/severe AD dementia = €10,345; P < .001). Public hospital stays comprised the majority of direct medical costs during the first semester following the visit (49.4% of the total costs), regardless of the severity of cognitive deficit. Caregiver burden increased with the severity of cognitive deficit (P < .0001). CONCLUSIONS Direct medical costs and caregiver burden rose from SCC to AD dementia; in patients with AD dementia, the direct medical costs increased over the 2 years after the first consultation. These results, in conjunction with data from other care components, will be critical to elucidate the potential economic value of a therapeutic intervention that slows AD progression.
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Affiliation(s)
- Virginie Dauphinot
- Clinical and Research Memory Centre of Lyon, Lyon Institute For Elderly, Lyon University Hospital, Lyon, France. .,University of Lyon, Lyon, France.
| | | | | | - Ray Su
- Biogen, Cambridge, MA, USA
| | | | - Pierre Krolak-Salmon
- Clinical and Research Memory Centre of Lyon, Lyon Institute For Elderly, Lyon University Hospital, Lyon, France.,University of Lyon, Lyon, France.,Neuroscience Research Centre of Lyon, Inserm 1048, CNRS, 5292, Lyon, France
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12
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Dams J, Grochtdreis T, König HH. Health-related quality of life of individuals sharing a household with persons with dementia. Qual Life Res 2021; 31:2319-2329. [PMID: 34919197 PMCID: PMC9250476 DOI: 10.1007/s11136-021-03065-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 11/26/2022]
Abstract
Introduction Previous research has found a negative effect of dementia on the health-related quality of life (HrQoL) of persons with dementia (PWD) and their primary informal caregivers. However, the impact of dementia on HrQoL of other individuals sharing a household with PWD has not been investigated to date. The current study therefore aimed to determine differences in the HrQoL between those sharing a household with PWD and those not living with PWD. In addition, factors related to the HrQoL of those sharing a household with PWD were evaluated. Methods The analyses were based on data from the German Socio-Economic Panel, using the SF-12 to measure HrQoL. Mixed-effects models were calculated to compare the HrQoL of those sharing a household with PWD and persons not living with PWD, as well as to determine factors related to the HrQoL of those sharing a household with PWD. Bootstrapping was used where residuals were not normally distributed. Results Mixed-effect models showed a significantly lower HrQoL among those sharing a household with PWD, compared to those not living with PWD. Number of diseases, number of persons in the household, marital status and educational level were significantly related to HrQoL among those sharing a household with PWD. Discussion The HrQoL of those sharing a household with PWD was reduced compared to persons not living with PWD. Further, those living with PWD in small households, or those with multi-morbidities had a lower HrQoL. Further research focusing on HrQoL in the social environment of PWD is needed.
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Affiliation(s)
- Judith Dams
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Thomas Grochtdreis
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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13
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Engel L, Ajdukovic M, Bucholc J, McCaffrey N. Valuation of Informal Care Provided to People Living With Dementia: A Systematic Literature Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1863-1870. [PMID: 34838285 DOI: 10.1016/j.jval.2021.04.1283] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/22/2021] [Accepted: 04/21/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES This study aimed to identify the methods used to determine the value of informal care provided to people living with dementia and to estimate the average hourly unit cost by valuation method. METHODS A literature search in MEDLINE Complete, CINAHL, PsycINFO, EconLit, EMBASE and NHS Economic Evaluation Database was undertaken. Following the screening of title, abstract, and full text, characteristics of eligible studies were extracted systematically and analyzed descriptively. The corresponding hourly cost estimates were converted into 2018 US dollars based on purchasing power parities for gross domestic product. RESULTS A total number of 111 articles were included in this review from 3106 post-deduplication records. Three main valuation methodologies were identified: the replacement cost method (n = 50), the opportunity cost approach (n = 36), and the stated preference method based on willingness to pay (n = 3), with 16 studies using multiple methods and 6 studies not specifying the valuation method. The amount of informal care increased as the condition of dementia progressed, which was reflected in the cost of informal care. The average hourly unit cost used to value informal care was US $16.78 (SD = US $12.11). Although the unit cost was approximately US $15 per hour when using the opportunity cost method and US $14 when using the stated preference method, the highest unit cost was obtained when using the replacement cost method (US $18.37, SD = US $13.12). CONCLUSIONS Although costs of informal care should be considered when undertaking an economic evaluation or estimating the overall costs of dementia from a policy and priority-setting perspective, further research into applying consistent approaches to valuation is warranted.
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Affiliation(s)
- Lidia Engel
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, Australia.
| | - Maja Ajdukovic
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Jessica Bucholc
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Nikki McCaffrey
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, Australia
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Key Mechanisms and Potential Implications of Hericium erinaceus in NLRP3 Inflammasome Activation by Reactive Oxygen Species during Alzheimer's Disease. Antioxidants (Basel) 2021; 10:antiox10111664. [PMID: 34829535 PMCID: PMC8615045 DOI: 10.3390/antiox10111664] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 12/11/2022] Open
Abstract
Alzheimer’s disease (AD) is the principal cause of dementia, and its incidence increases with age. Altered antioxidant systems and inflammation have an important role in the etiology of neurodegenerative disorders. In this study, we evaluated the effects of Hericium erinaceus, a nutritional mushroom with important antioxidant effects, in a rat model of AD. Animals were injected with 70 mg/Kg of AlCl3 daily for 6 weeks, and Hericium erinaceus was administered daily by gavage. Before the experiment’s end date, behavioral test training was performed. At the end of the study, behavioral changes were assessed, and the animals were euthanized. Brain tissues were harvested for further analysis. AlCl3 mainly accumulates in the hippocampus, the principal region of the brain involved in memory functions and learning. Hericium erinaceus administration reduced behavioral changes and hippocampal neuronal degeneration. Additionally, it reduced phosphorylated Tau levels, aberrant APP overexpression, and β-amyloid accumulation. Moreover, Hericium erinaceus decreased the pro-oxidative and pro-inflammatory hippocampal alterations induced by AD. In particular, it reduced the activation of the NLRP3 inflammasome components, usually activated by increased oxidative stress during AD. Collectively, our results showed that Hericium erinaceus has protective effects on behavioral alteration and histological modification associated with AD due to the modulation of the oxidative and inflammatory pathways, as well as regulating cellular brain stress.
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15
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Shon C, Yoon H. Health-economic burden of dementia in South Korea. BMC Geriatr 2021; 21:549. [PMID: 34645415 PMCID: PMC8515696 DOI: 10.1186/s12877-021-02526-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 10/07/2021] [Indexed: 11/17/2022] Open
Abstract
Background This population-based study estimated the health-economic costs of dementia from a societal perspective using nationally representative data from 2015 to 2019 and analysed recent trends in Korea. Methods The prevalence of and mortality due to dementia were calculated using the National Health Insurance claims data and population census. The health-economic burden due to dementia was estimated using a prevalence-based approach, including the number of dementia patients and the number of deaths resulting from dementia during 2015–2019. The health-economic burden was presented separately as the national burden and the burden per capita by summing the direct and indirect costs. Results Between 2015 and 2019, the prevalence of dementia among the elderly aged 65 years or older based on clinical diagnosis increased from 5.9 to 7.3%, with approximately 588000 elderly dementia patients in Korea. The total health-economic cost of dementia increased by about 1.5 times in the last 5 years and was estimated to be about USD 4218 million. Direct costs were 52.0% in 2019, and the proportion has been steadily increasing over the past 5 years; indirect costs accounted for 48.0% of the total burden, mainly from family members and caregivers. The health-economic cost per capita due to dementia was approximately USD 6957. Conclusions The burden of dementia in Korea is expected to considerably increase alongside the elderly population in the future. Health policies addressing the prevention and management of dementia should be prioritised.
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Affiliation(s)
- Changwoo Shon
- Department of Urban Society Research, The Seoul Institute, 57 Nambusunhwan-ro, 340-gil, Seocho-gu, Seoul, 06756, Korea
| | - Hyejung Yoon
- Department of Urban Society Research, The Seoul Institute, 57 Nambusunhwan-ro, 340-gil, Seocho-gu, Seoul, 06756, Korea.
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16
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Alva-Dìaz C, Malaga M, Rodriguez-Calienes A, Morán-Mariños C, Velásquez-Rimachi V, Custodio N. Costs Related to Frontotemporal Dementia in Latin America: A Scoping Review of Economic Health Studies. Front Neurol 2021; 12:684850. [PMID: 34497574 PMCID: PMC8419437 DOI: 10.3389/fneur.2021.684850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/30/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: Frontotemporal dementia (FTD) is a complex syndrome characterized by changes in behavior, language, executive control, and motor symptoms. Its annual economic burden per patient in developed countries has been classified as considerable, amounting to US$119,654 per patient, almost double the patient costs reported for Alzheimer's disease. However, there is little information regarding cost-of-illness (COI) for FTD in Latin-America (LA). Aim: To describe the costs related to FTD in LA. Methods: We included COI studies on FTD conducted in LA published in English, Spanish, or Portuguese from inception to September 2020. We carried out a systematic search in Pubmed/Medline, Scopus, Web of Science, Scielo, Cochrane, and gray literature. For quality assessment, we used a COI assessment tool available in the literature. All costs were reported in USD for 1 year and adjusted for inflation. Results: We included three studies from Argentina, Brazil, and Peru. Direct costs (DCs) included medication (from US$959.20 to US$ 4,279.20), health care costs (from US$ 2,275.80 to US$7,856.16), and caregiver costs (from US$9,634.00 to US$28,730.28). Indirect costs (ICs) amounted to US$43,076.88. Conclusions: In LA countries, the reporting of costs related to FTD continues to be oriented toward DCs. They remain lower than in developed countries, possibly due to the limited health budget allocated. Only one Brazilian report analyzed ICs, representing the highest percentage of the total costs. Therefore, studies on the COI of this disease in LA are essential, focusing on both out-of-pocket spending and the potential economic loss to patients' homes and families.
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Affiliation(s)
- Carlos Alva-Dìaz
- Grupo de Investigación Neurociencia, Efectividad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Peru
| | - Marco Malaga
- Grupo Estudiantil de Investigación en Neurociencias, Sociedad de Estudiantes de Medicina Humana de la Universidad de San Martin de Porres, Lima, Peru
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Lima, Peru
- Red de Eficacia Clínica y Sanitaria, Lima, Peru
| | - Aaron Rodriguez-Calienes
- Grupo Estudiantil de Investigación en Neurociencias, Sociedad de Estudiantes de Medicina Humana de la Universidad de San Martin de Porres, Lima, Peru
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Lima, Peru
- Red de Eficacia Clínica y Sanitaria, Lima, Peru
| | - Cristian Morán-Mariños
- Red de Eficacia Clínica y Sanitaria, Lima, Peru
- Unidad de Investigación en Bibliometría, Universidad San Ignacio de Loyola, Lima, Peru
| | - Victor Velásquez-Rimachi
- Grupo de Investigación Neurociencia, Efectividad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Peru
- Red de Eficacia Clínica y Sanitaria, Lima, Peru
| | - Nilton Custodio
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
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17
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Sontheimer N, Konnopka A, König HH. The Excess Costs of Dementia: A Systematic Review and Meta-Analysis. J Alzheimers Dis 2021; 83:333-354. [PMID: 34334395 DOI: 10.3233/jad-210174] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Dementia is one of the costliest diseases for health care systems with growing importance for policy makers. OBJECTIVE The aim of this study is to systematically review the current literature of excess cost studies for dementia and to analyze excess costs in a meta-analysis. METHODS A systematic literature search was conducted in PubMed, EconLit, NHS-EED, and Cochrane Library. 22 studies were included and assigned to one of three subgroups according to the time period that they analyzed during disease progression: the time of diagnosis, the time between diagnosis and death, and the time prior to death. Excess costs were analyzed using the ratio of means (ROM) and meta-analysis was performed by pooling ROMs in a random effects model. RESULTS Total costs were significantly higher for demented persons compared to non-demented persons at the time of diagnosis (ROM: 2.08 [1.71, 2.54], p < 0.00001, I2 = 98%) and in the time period between diagnosis and death (ROM: 2.19 [1.97, 2.44], p < 0.00001, I2 = 100%). The ROM was highest for professional home care (ROM: 4.96 [2.62, 9.40], p < 0.0001, I2 = 88%) and for nursing facilities (ROM: 4.02 [2.53, 6.40], p < 0.00001, I2 = 100%) for the time period between diagnosis and death. CONCLUSION This meta-analysis is the first to assess excess costs of dementia by the ROM method on a global scale. We conclude that our findings demonstrate that costs of dementia constitute a substantial economic burden.
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Affiliation(s)
- Nadine Sontheimer
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Konnopka
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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18
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Varshney SU, Varshney U, McCall WV. A proposal for a novel approach to reduce burdens of care for people with dementia: A hypothesis. Alzheimers Dement 2021; 18:211-221. [PMID: 34129281 DOI: 10.1002/alz.12388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 04/22/2021] [Indexed: 11/06/2022]
Abstract
Cognitive impairment of dementia patients affects their ability to communicate and cooperate with care. Dementia patients need a specialized communication to increase their cooperation during daily care and a scale to measure cooperation with care. To improve communication, we created and applied a digital communication platform (DCP) in an observational study. To measure cooperation with care, we created and tested psychometric properties of the Cooperation with Care Scale-Revised (CWCS-R) in an institutional review board-approved 6-week prospective study. DCP intervention was associated with decreased agitation and use of psychotropic medications for nursing home (NH) dementia patients. CWCS-R is both a reliable and valid tool to measure cooperation with care in NH dementia patients. Innovations in communication with dementia patients and a scale to measure cooperation with care could reduce burdens of care and improve quality of life for patients, their family members, and staff. It may potentially help decrease cost of dementia care.
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Affiliation(s)
- Smita U Varshney
- AlzhaCare LLC, Kennesaw, Georgia, USA.,Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Upkar Varshney
- Computer Information Systems Department, Georgia State University, Atlanta, Georgia, USA
| | - William V McCall
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
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19
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Robinson RL, Rentz DM, Andrews JS, Zagar A, Kim Y, Bruemmer V, Schwartz RL, Ye W, Fillit HM. Costs of Early Stage Alzheimer's Disease in the United States: Cross-Sectional Analysis of a Prospective Cohort Study (GERAS-US)1. J Alzheimers Dis 2021; 75:437-450. [PMID: 32250304 PMCID: PMC7306889 DOI: 10.3233/jad-191212] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Costs associated with early stages of Alzheimer's disease (AD; mild cognitive impairment [MCI] and mild dementia [MILD]) are understudied. OBJECTIVE To compare costs associated with MCI and MILD due to AD in the United States. METHODS Data included baseline patient/study partner medical history, healthcare resource utilization, and outcome assessments as part of a prospective cohort study. Direct, indirect, and total societal costs were derived by applying standardized unit costs to resources for the 1-month pre-baseline period (USD2017). Costs/month for MCI and MILD cohorts were compared using analysis of variance models. To strengthen the confidence of diagnosis, amyloid-β (Aβ) tests were included and analyses were replicated stratifying within each cohort by amyloid status [+ /-]. RESULTS Patients (N = 1327) with MILD versus MCI had higher total societal costs/month ($4243 versus $2816; p < 0.001). These costs were not significantly different within each severity cohort by amyloid status. The largest fraction of overall costs were informal caregiver costs (45.1%) for the MILD cohort, whereas direct medical patient costs were the largest for the MCI cohort (39.0%). Correspondingly, caregiver time spent on basic activities of daily living (ADLs), instrumental ADLs, and supervision time was twice as high for MILD versus MCI (all p < 0.001). CONCLUSION Early AD poses a financial burden, and despite higher functioning among those with MCI, caregivers were significantly impacted. The major cost driver was the patient's clinical cognitive-functional status and not amyloid status. Differences were primarily due to rising need for caregiver support.
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Affiliation(s)
| | - Dorene M Rentz
- Harvard Medical School, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Yongin Kim
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | | | - Wenyu Ye
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Howard M Fillit
- Geriatric Medicine, Palliative Care and Neuroscience, The Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Alzheimer's Drug Discovery Foundation, New York, NY, USA
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20
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Pitkala KH, Laakkonen ML, Kallio EL, Kautiainen H, Raivio MM, Tilvis RS, Strandberg TE, Ohman H. Monetary value of informal caregiving in dementia from a societal perspective. Age Ageing 2021; 50:861-867. [PMID: 33000145 DOI: 10.1093/ageing/afaa196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 08/02/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Dementia is a condition which results in a high cost of care, a significant proportion of which is the cost associated with informal care. In previous studies, informal caregiving has been challenging to assess due to difficulties in estimating the true time spent on caregiving work and how to value caregivers' time. The aim of this study was to compare the costs of dementia among patients living alone and among those living with a caregiver to show the monetary value of informal caregiving from a societal perspective. METHODS Data from our four dementia trials using the same measures were combined, allowing the inclusion of 604 participants. Participants were followed up for 2 years or until death for their use of health and social services. Use of all services was retrieved from medical/social records. We also included the costs of lost productivity of those caregivers who were not retired. RESULTS The total mean cost of services and lost productivity was €22,068/person-year (pyrs). Participants living alone had a mean cost of €45,156/pyrs, whereas those living with a spouse had a mean cost of €16,416/pyrs (mean cost ratio 2.99, 95% confidence interval 2.64-3.39). Participants living alone and having <15 Mini-Mental State Examination points had higher costs than people with dementia in institutional care. CONCLUSIONS Detailed data of service use and characteristics of people with dementia showed that from a societal perspective, living alone is a very strong determinant of service use in dementia. Informal caregivers do invaluable work for society.
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Affiliation(s)
- Kaisu H Pitkala
- University of Helsinki, Department of General Practice, Helsinki, Finland and Helsinki University Hospital, Unit of Primary Health Care, Helsinki, Finland
| | - Marja-Liisa Laakkonen
- University of Helsinki, Department of General Practice, Helsinki, Finland and Helsinki University Hospital, Unit of Primary Health Care, Helsinki, Finland
- Geriatric Clinic, Department of Social Services and Health Care, Laakso Hospital, Helsinki, Finland
| | - Eeva-Liisa Kallio
- University of Helsinki, Department of General Practice, Helsinki, Finland and Helsinki University Hospital, Unit of Primary Health Care, Helsinki, Finland
- Clinical Neurosciences, Neuropsychology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hannu Kautiainen
- University of Helsinki, Department of General Practice, Helsinki, Finland and Helsinki University Hospital, Unit of Primary Health Care, Helsinki, Finland
| | - Minna M Raivio
- University of Helsinki, Department of General Practice, Helsinki, Finland and Helsinki University Hospital, Unit of Primary Health Care, Helsinki, Finland
| | - Reijo S Tilvis
- University of Helsinki, Clinicum, Department of Geriatrics, Helsinki, Finland
| | - Timo E Strandberg
- University of Helsinki, Clinicum, Department of Geriatrics, Helsinki, Finland
- Helsinki University Hospital, Clinics of Internal Medicine and Geriatrics, Helsinki, Finland
| | - Hannareeta Ohman
- University of Helsinki, Department of General Practice, Helsinki, Finland and Helsinki University Hospital, Unit of Primary Health Care, Helsinki, Finland
- Helsinki University Hospital, Clinics of Internal Medicine and Geriatrics, Helsinki, Finland
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21
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Walsh S, Pertl M, Gillespie P, Lawlor B, Brennan S, O'Shea E. Factors influencing the cost of care and admission to long-term care for people with dementia in Ireland. Aging Ment Health 2021; 25:512-520. [PMID: 31847539 DOI: 10.1080/13607863.2019.1699901] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To explore the factors associated with the cost of care and admission to long-term care (LTC) for people with dementia living at home in Ireland. METHODS Data on formal and informal resource use for people with dementia, and their LTC admission, were obtained from a national study of spousal dementia caregivers. Functional status was measured using the Bristol Activities of Daily Living Scale, while behavioural and psychiatric symptoms were evaluated using the Neuropsychiatric Inventory. Multivariable regression analysis was used to model costs and the predictors of LTC admission. RESULTS Physical and cognitive symptoms were significantly associated with costs. Severely impaired functional ability was associated with a €2,308 increase in mean total 30-day monthly costs. Psychosis was associated with a €335 increase in primary and community 30-day monthly care costs. These factors also make it more likely that a person with dementia is admitted to LTC. Having an older caregiver also increases the risk of admission to LTC, while living in a rural area and having a female caregiver reduce the likelihood of admission. CONCLUSIONS Dependency matters for the cost of care. Physical and cognitive symptoms, caregiver age and gender, and geographic location are significant predictors of admission to LTC.
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Affiliation(s)
- Sharon Walsh
- Centre for Economic and Social Research on Dementia, Discipline of Economics, National University of Ireland Galway, Galway, Ireland
| | - Maria Pertl
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Paddy Gillespie
- Health Economic and Policy Analysis Centre, Discipline of Economics, National University of Ireland Galway, Galway, Ireland
| | - Brian Lawlor
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland
| | - Sabina Brennan
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland
| | - Eamon O'Shea
- Centre for Economic and Social Research on Dementia, Discipline of Economics, National University of Ireland Galway, Galway, Ireland
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22
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van Lier LI, Bosmans JE, van der Roest HG, Heymans MW, Garms-Homolová V, Declercq A, V Jónsson P, van Hout HP. Development and Validation of a Prediction Model for 6-Month Societal Costs in Older Community Care-Recipients in Multiple Countries; the IBenC Study. Health Serv Insights 2021; 13:1178632920980462. [PMID: 33488092 PMCID: PMC7768843 DOI: 10.1177/1178632920980462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 11/18/2020] [Indexed: 11/16/2022] Open
Abstract
This study aims to develop and validate a prediction model of societal costs during a period of 6-months in older community care-recipients across multiple European countries. Participants were older community care-recipients from 5 European countries. The outcome measure was mean 6-months total societal costs of resource utilisation (healthcare and informal care). Potential predictors included sociodemographic characteristics, functional limitations, clinical conditions, and diseases/disorders. The model was developed by performing Linear Mixed Models with a random intercept for the effect of country and validated by an internal-external validation procedure. Living alone, caregiver distress, (I)ADL impairment, required level of care support, health instability, presence of pain, behavioural problems, urinary incontinence and multimorbidity significantly predicted societal costs during 6 months. The model explained 32% of the variation within societal costs and showed good calibration in Iceland, Finland and Germany. Minor model adaptations improved model performance in The Netherland and Italy. The results can provide a valuable orientation for policymakers to better understand cost development among older community care-recipients. Despite substantial differences of countries’ care systems, a validated cross-national set of key predictors could be identified.
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Affiliation(s)
- Lisanne I van Lier
- Department of General Practice and Medicine of Older People, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, and Department on Aging, Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, Utrecht, The Netherlands
| | - Judith E Bosmans
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Henriëtte G van der Roest
- Department of General Practice and Medicine of Older People, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, and Department on Aging, Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, Utrecht, The Netherlands
| | - Martijn W Heymans
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Vjenka Garms-Homolová
- Department III, Economy and Law, Hochschule für Technik und Wirtschaft Berlin, Berlin, Germany
| | - Anja Declercq
- LUCAS, Centre for Care Research and Consultancy, and CESO, Center for Sociological Research, KU Leuven (University of Leuven), Leuven, Belgium
| | - Pálmi V Jónsson
- Department of Geriatrics, Landspitali University Hospital, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Hein Pj van Hout
- Department of General Practice and Medicine of Older People, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, and Department on Aging, Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, Utrecht, The Netherlands
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23
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Saeedi M, Rashidy-Pour A. Association between chronic stress and Alzheimer's disease: Therapeutic effects of Saffron. Biomed Pharmacother 2020; 133:110995. [PMID: 33232931 DOI: 10.1016/j.biopha.2020.110995] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/28/2020] [Accepted: 11/01/2020] [Indexed: 12/19/2022] Open
Abstract
Chronic stress and high levels of glucocorticoids produce functional and structural changes in brain and especially in the hippocampus, an important limbic system structure that plays a key role in cognitive functions including learning and memory. Alzheimer's disease (AD) is a chronic neurodegenerative disease that usually starts slowly and worsens over time. Indeed, cognitive dysfunction, neuronal atrophy, and synaptic loss are associated with both AD and chronic stress. Recent preclinical and clinical studies have highlighted a possible link between chronic stress, cognitive decline and the development of AD. It is suggested that Tau protein is an essential mediator of the neurodegenerative effects of stress and glucocorticoids towards the development of AD pathology. Recent findings from animal and humans studies demonstrated that saffron and its main constitutive crocin are effective against chronic stress-induced cognitive dysfunction and oxidative stress and slowed cognitive decline in AD. The inhibitory actions on acetylcholinesterase activity, aggregation of beta-amyloid protein into amyloid plaques and tau protein into neurofibrillary tangles, and also the antioxidant, anti-inflammatory, and the promotion of synaptic plasticity effects are among the possible mechanisms to explain the neuroprotective effects of saffron. New evidences demonstrate that saffron and its main component crocin might be a promising target for cognition improvement in AD and stress-related disorders.
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Affiliation(s)
- Mohammad Saeedi
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran
| | - Ali Rashidy-Pour
- Research Center of Physiology, Semnan University of Medical Sciences, Semnan, Iran.
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24
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Afonso-Argilés FJ, Meyer G, Stephan A, Comas M, Wübker A, Leino-Kilpi H, Lethin C, Saks K, Soto-Martin M, Sutcliffe C, Verbeek H, Zabalegui A, Renom-Guiteras A. Emergency department and hospital admissions among people with dementia living at home or in nursing homes: results of the European RightTimePlaceCare project on their frequency, associated factors and costs. BMC Geriatr 2020; 20:453. [PMID: 33153444 PMCID: PMC7643440 DOI: 10.1186/s12877-020-01835-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 10/14/2020] [Indexed: 11/21/2022] Open
Abstract
Background Evidence is lacking on the differences between hospitalisation of people with dementia living in nursing homes and those living in the community. The objectives of this study were: 1) to describe the frequency of hospital admission among people with dementia in eight European countries living in nursing homes or in the community, 2) to examine the factors associated with hospitalisation in each setting, and 3) to evaluate the costs associated with it. Methods The present study is a secondary data analysis of the RightTimePlaceCare European project. A cross-sectional survey was conducted with data collected from people with dementia living at home or who had been admitted to a nursing home in the last 3 months, as well as from their caregivers. Data on hospital admissions at 3 months, cognitive and functional status, neuropsychiatric symptoms, comorbidity, polypharmacy, caregiver burden, nutritional status, and falls were assessed using validated instruments. Multivariate regression models were used to investigate the factors associated with hospital admission for each setting. Costs were estimated by multiplying quantities of resources used with the unit cost of each resource and inflated to the year 2019. Results The study sample comprised 1700 people with dementia living in the community and nursing homes. Within 3 months, 13.8 and 18.5% of people living in nursing homes and home care, respectively, experienced ≥1 hospital admission. In the nursing home setting, only polypharmacy was associated with a higher chance of hospital admission, while in the home care setting, unintentional weight loss, polypharmacy, falls, and more severe caregiver burden were associated with hospital admission. Overall, the estimated average costs per person with dementia/year among participants living in a nursing home were lower than those receiving home care. Conclusion Admission to hospital is frequent among people with dementia, especially among those living in the community, and seems to impose a remarkable economic burden. The identification and establishment of an individualised care plan for those people with dementia with polypharmacy in nursing homes, and those with involuntary weight loss, accidental falls, polypharmacy and higher caregiver burden in the home care setting, might help preventing unnecessary hospital admissions.
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Affiliation(s)
- F Javier Afonso-Argilés
- Department of Geriatric Medicine and Palliative Care. Badalona Serveis Assistencials, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gabriele Meyer
- Department of Nursing Science, Witten/Herdecke University, Witten, Germany. .,Institute of Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
| | - Astrid Stephan
- Department of Nursing Science, Witten/Herdecke University, Witten, Germany.,Institute of Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Mercè Comas
- Department of Epidemiology and Evaluation. Hospital del Mar, Parc de Salut Mar, Barcelona, Spain.,Member of the Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
| | - Ansgar Wübker
- RWI - Leibniz-Institute for Economic Research, Leibniz Science Campus Ruhr and RUB, Essen, Germany
| | - Helena Leino-Kilpi
- Department of Nursing Science and Nurse Director, Turku University Hospital, University of Turku, Turku, Finland
| | - Connie Lethin
- Department of Health Sciences. Faculty of Medicine, Lund University, SE-221 00, Lund, Sweden.,Clinical Memory Research Unit. Department of Clinical Sciences, Lund University, SE-221 00, Lund, Sweden
| | - Kai Saks
- Department of Internal Medicine, University of Tartu, Tartu, Estonia
| | - Maria Soto-Martin
- Department of Geriatric Medicine, Gerontopole, Alzheimer Disease Research Center, Inserm UMR 1027, University Hospital of Toulouse, Toulouse, France
| | | | - Hilde Verbeek
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Adelaida Zabalegui
- Hospital Clinic de Barcelona, Barcelona, Spain.,School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Anna Renom-Guiteras
- Universitat Autònoma de Barcelona, Barcelona, Spain.,Member of the Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain.,Department of Geriatric Medicine, Parc de Salut Mar, Barcelona, Spain
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25
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Maresova P, Hruska J, Klimova B, Barakovic S, Krejcar O. Activities of Daily Living and Associated Costs in the Most Widespread Neurodegenerative Diseases: A Systematic Review. Clin Interv Aging 2020; 15:1841-1862. [PMID: 33061334 PMCID: PMC7538005 DOI: 10.2147/cia.s264688] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/04/2020] [Indexed: 12/20/2022] Open
Abstract
Nowadays, the population is rapidly ageing because of increasing life expectancy and decreasing birth rates. Thus, the purpose of this systematic review is to prepare a comprehensive overview which identifies the activities of daily living (ADLs) that are gradually reduced among patients with dementia, as well as explore the therapies applied in relation to dementia and how they effectively improve the quality of life (QoL) of patients and caregivers. Furthermore, we aim to summarise the ADL activities influenced by therapies and examine the treatment costs and care for patients so that recommendations for research and development (R&D) can be made to improve both the QoL of people with dementia and cost-saving measures. The research focuses on four selected neurodegenerative diseases: Alzheimer, Parkinson, vascular dementia, and amyotrophic lateral sclerosis. Therefore, the peer-reviewed English written articles from 2014 to 2019 were searched between September 1 and December 13, 2019. Twenty-seven papers were included in the analysis. The results show that essential assistance occurs in connection with activities: eating, drinking, dressing, bathing, personal hygiene, use of the toilet, and transport. By contrast, shopping or cleaning is not addressed as much. A lower ability to take care of oneself is connected with poor patient health and higher social care costs because the patient requires care from external sources, such as home aid or nurse visits. The challenge that remains is to shift new knowledge from scientific disciplines and connect it with the needs of patients to remove legitimate barriers and increase the acceptance of new solutions by popularisation. Additionally, regarding the burden on caregivers, it would be appropriate to promote this area of education and employment so that family members can use formal caregivers, ensuring them free time and much-needed rest.
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Affiliation(s)
- Petra Maresova
- Department of Economics, Faculty of Informatics and Management, University of Hradec Kralove, Hradec Kralove 500 03, Czech Republic
| | - Jan Hruska
- Department of Economics, Faculty of Informatics and Management, University of Hradec Kralove, Hradec Kralove 500 03, Czech Republic
| | - Blanka Klimova
- Department of Applied Linguistics, Faculty of Informatics and Management, University of Hradec Kralove, Hradec Kralove 500 03, Czech Republic
| | - Sabina Barakovic
- Faculty of Transport and Communications, University of Sarajevo, Sarajevo 71000, Bosnia and Herzegovina
| | - Ondrej Krejcar
- Center for Basic and Applied Science, Faculty of Informatics and Management, University of Hradec Kralove, Hradec Kralove 500 03, Czech Republic
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26
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Ydstebø AE, Benth JŠ, Bergh S, Selbæk G, Vossius C. Informal and formal care among persons with dementia immediately before nursing home admission. BMC Geriatr 2020; 20:296. [PMID: 32811440 PMCID: PMC7436969 DOI: 10.1186/s12877-020-01703-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 08/12/2020] [Indexed: 11/14/2022] Open
Abstract
Background Dementia is a care intensive disease, especially in the later stages, implying in many cases a substantial carer burden. This study assesses the use of formal and informal care resources among persons with dementia during the last month before nursing home admission. It also describes main providers of informal care and assesses the extent of informal care rendered by the extended social network. Methods In this cross-sectional study, we collected data about persons with dementia that were newly admitted to a nursing home in Norway. Information about the amount of formal and informal care during the last 4 weeks preceding nursing home admission was collected from the primary caregivers. Clinical data were collected by examining the patients, while sociodemographic data was collected from the patients’ files. Results A total of 395 persons with dementia were included. The amount of informal care provided by the family caregiver was 141.9 h per month SD = 227.4. Co-resident patients received five times more informal care than non-co-residents. Informal care from the extended social network was provided to 212 patients (53.7%) with a mean of 5.6 (SD = 11.2) hours per month and represented 3.8% of the total informal care rendered to the patients. Formal care was provided to 52.7% of the patients with a mean of 18.0 (SD = 50.1) hours per month. Co-residency was significantly associated with more informal care, and the associations varied with respect to age, relation to the caregiver, and the caregiver’s working situation. Good/excellent general health was associated with less formal care. Conclusion Persons with dementia on the verge of admission to a nursing home are mainly supported by the family caregiver, and the use of informal care is particularly high among co-residents. In order to delay nursing home admission, future research should explore the unrealized care potential in extended social networks, as well as the potential for increasing the number of recipients of formal care services.
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Affiliation(s)
- Arnt Egil Ydstebø
- Centre for Age-related Medicine, Stavanger University Hospital, Stavanger, Norway. .,Centre for Development of Institutional and Home Care Services Rogaland, Stavanger, Norway. .,Research centre for Age-related Functional decline and Disease, Innlandet Hospital Trust, Postboks 68, N-2312, Ottestad, Norway.
| | - Jurate Šaltytė Benth
- Research centre for Age-related Functional decline and Disease, Innlandet Hospital Trust, Postboks 68, N-2312, Ottestad, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Akershus, Norway
| | - Sverre Bergh
- Research centre for Age-related Functional decline and Disease, Innlandet Hospital Trust, Postboks 68, N-2312, Ottestad, Norway.,Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Geir Selbæk
- Research centre for Age-related Functional decline and Disease, Innlandet Hospital Trust, Postboks 68, N-2312, Ottestad, Norway.,Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Corinna Vossius
- Centre for Age-related Medicine, Stavanger University Hospital, Stavanger, Norway.,Centre for Development of Institutional and Home Care Services Rogaland, Stavanger, Norway
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Abstract
AbstractCurrent policies aim to promote and develop community-based support of disabled elderly persons, yet knowledge of the cost implications is insufficient. Thus, we aimed to estimate, for three disability profiles and three presence levels of the main informal carer (none, non-cohabitant, cohabitant), the cost of formal and informal support currently provided at home in Belgium. In this cross-sectional study, a sample of 5,642 disabled elderly persons living at home was established between 2010 and 2016. The administrative database of the Belgian public healthcare insurance was merged with other prospective data on social care service utilisation, informal care and disability. The total cost of formal support ranged from €725 to €1,344 (on average, per person, per month), depending on the three disability profiles identified. Twenty-five per cent of persons with the highest level of disability (important functional limitations and cognitive impairment) and helped by a cohabitant carer, had a low total cost of formal support: below €382 per month. Informal care represented the main cost component of total support costs in the three disability profiles (between 64 and 76%). To prevent the worsening of situations of disabled older persons and their informal carers, better detection of seriously disabled persons with low levels of formal support is crucial.
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28
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Burley CV, Livingston G, Knapp MRJ, Wimo A, Norman R, Brodaty H. Time to invest in prevention and better care of behaviors and psychological symptoms associated with dementia. Int Psychogeriatr 2020; 32:1-6. [PMID: 32228722 DOI: 10.1017/s104161022000037x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Claire V Burley
- Dementia Centre for Research Collaboration, University of New South Wales, Sydney, Australia
| | - Gill Livingston
- Department of Old Age Psychiatry, Division of Psychiatry, University College London, London, UK
| | - Martin R J Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Anders Wimo
- Division of Neurogeriatrics, Department for Neurobiology, Care Sciences and Society, Karolinska Institute, Solna, Sweden
| | - Richard Norman
- School of Public Health, Curtin University, Perth, Australia
| | - Henry Brodaty
- Dementia Centre for Research Collaboration, University of New South Wales, Sydney, Australia
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29
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Healthcare utilization and monetary costs associated with agitation in UK care home residents with advanced dementia: a prospective cohort study. Int Psychogeriatr 2020; 32:359-370. [PMID: 31948510 DOI: 10.1017/s1041610219002059] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Nearly half of care home residents with advanced dementia have clinically significant agitation. Little is known about costs associated with these symptoms toward the end of life. We calculated monetary costs associated with agitation from UK National Health Service, personal social services, and societal perspectives. DESIGN Prospective cohort study. SETTING Thirteen nursing homes in London and the southeast of England. PARTICIPANTS Seventy-nine people with advanced dementia (Functional Assessment Staging Tool grade 6e and above) residing in nursing homes, and thirty-five of their informal carers. MEASUREMENTS Data collected at study entry and monthly for up to 9 months, extrapolated for expression per annum. Agitation was assessed using the Cohen-Mansfield Agitation Inventory (CMAI). Health and social care costs of residing in care homes, and costs of contacts with health and social care services were calculated from national unit costs; for a societal perspective, costs of providing informal care were estimated using the resource utilization in dementia (RUD)-Lite scale. RESULTS After adjustment, health and social care costs, and costs of providing informal care varied significantly by level of agitation as death approached, from £23,000 over a 1-year period with no agitation symptoms (CMAI agitation score 0-10) to £45,000 at the most severe level (CMAI agitation score >100). On average, agitation accounted for 30% of health and social care costs. Informal care costs were substantial, constituting 29% of total costs. CONCLUSIONS With the increasing prevalence of dementia, costs of care will impact on healthcare and social services systems, as well as informal carers. Agitation is a key driver of these costs in people with advanced dementia presenting complex challenges for symptom management, service planners, and providers.
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30
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Vandepitte S, Van Wilder L, Putman K, Van Den Noortgate N, Verhaeghe S, Trybou J, Annemans L. Factors associated with costs of care in community-dwelling persons with dementia from a third party payer and societal perspective: a cross-sectional study. BMC Geriatr 2020; 20:18. [PMID: 31948386 PMCID: PMC6966839 DOI: 10.1186/s12877-020-1414-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/03/2020] [Indexed: 12/15/2022] Open
Abstract
Background Besides the importance of estimating the global economic impact of care for persons with dementia, there is an emerging need to identify the key factors associated with this cost. The aim of this study was to analyze associations between the cost of care in community-dwelling persons with dementia and caregiver characteristics from both the healthcare third party payer perspective and the societal perspective. Methods Several characteristics based on the cross-sectional data of 355 dyads of informal caregivers and persons with dementia living in Belgium were identified to include in a log-gamma generalized linear model and were used in a multiple linear regression model with bootstrapping to test robustness. Results The mean monthly cost of care for a community-dwelling person with dementia was estimated at € 2339 (95% CI € 2133 – € 2545) per person from a societal perspective and at € 968 (95% CI € 825 – € 1111) per person from a third party payer viewpoint. Informal care accounted for the majority of the monthly costs from the societal perspective. Community based healthcare resource use represented the largest cost from the third party perspective. According to the regression analyses, a higher level of functional dependency of the person with dementia and a higher educational level of the caregiver were associated with a higher monthly cost from both a third party payer perspective and a societal perspective. In addition, being retired and a higher quality of life in the caregivers were associated with a lower monthly cost of care from the societal perspective. Conclusions Several characteristics of the caregiver and the person with dementia were associated with the monthly costs of care from a third party payer and a societal perspective. Despite the lack of clear causal relationships, the results of this study can assist policy makers in planning and financing future dementia care. Trial registration Clinicaltrials.gov NCT02630446, December 15, 2015.
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Affiliation(s)
- S Vandepitte
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - L Van Wilder
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - K Putman
- Faculty of Medicine and Pharmacy, Department of Medical Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - N Van Den Noortgate
- Department of Internal medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - S Verhaeghe
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - J Trybou
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - L Annemans
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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DiGiacomo M, Chang S, Luckett T, Agar M, Phillips J, Lam L. Financial stress experienced by informal carers of adults with a chronic disease: Results from an Australian population-based cross-sectional survey. Australas J Ageing 2019; 39:254-262. [PMID: 31680413 DOI: 10.1111/ajag.12739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 09/16/2019] [Accepted: 09/18/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To identify caregiving characteristics that are associated with financial stress in Australian carers of people with a chronic disease. METHODS Data were collected via the South Australian Health Omnibus, an annual population-based, cross-sectional survey. Individuals who provided care to someone with prevalent chronic conditions were asked about financial stress and caregiving characteristics. RESULTS Of 32.4% (988/3047) who were carers, 13.4% (132/988) experienced financial stress. Adjusting for age and household income, providing more than 20 hours of care per week (AOR = 2.39, 95% CI = 1.48-3.86), transport assistance (AOR = 1.89, 95% CI = 1.15-3.09) and assistance with household tasks (AOR = 1.92, 95% CI = 1.14-3.26) and caring for a person with a mental illness (AOR = 2.01, 95% CI = 1.24-3.28) were associated with a significant increase in odds of experiencing financial stress. Caring for a person with cancer (AOR = 0.49, 95% CI = 0.30-0.81) or dementia (AOR = 0.40, 95% CI = 0.21-0.76) was associated with decrease in odds. CONCLUSIONS Financial stress was reported by more than 13% of carers, and factors other than household income were implicated.
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Affiliation(s)
- Michelle DiGiacomo
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia
| | - Sungwon Chang
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia
| | - Tim Luckett
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia
| | - Meera Agar
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia.,South Western Sydney Clinical School, Liverpool Hospital, University of New South Wales (UNSW), Liverpool, NSW, Australia.,Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Jane Phillips
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia
| | - Lawrence Lam
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia.,Tung Wah College, Hong Kong SAR, China
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Green C, Handels R, Gustavsson A, Wimo A, Winblad B, Sköldunger A, Jönsson L. Assessing cost-effectiveness of early intervention in Alzheimer's disease: An open-source modeling framework. Alzheimers Dement 2019; 15:1309-1321. [PMID: 31402324 PMCID: PMC10490554 DOI: 10.1016/j.jalz.2019.05.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/06/2019] [Accepted: 05/15/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION We develop a framework to model disease progression across Alzheimer's disease (AD) and to assess the cost-effectiveness of future disease-modifying therapies (DMTs) for people with mild cognitive impairment (MCI) due to AD. METHODS Using data from the US National Alzheimer's Coordinating Center, we apply survival analysis to estimate transition from predementia to AD dementia and ordered probit regression to estimate transitions across AD dementia stages. We investigate the cost-effectiveness of a hypothetical treatment scenario for people in MCI due to AD. RESULTS We present an open-access model-based decision-analytic framework. Assuming a modest DMT treatment effect in MCI, we predict extended life expectancy and a reduction in time with AD dementia. DISCUSSION Any future DMT for AD is expected to pose significant economic challenges across all health-care systems, and decision-analytic modeling will be required to assess costs and outcomes. Further developments are needed to inform these health policy considerations.
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Affiliation(s)
- Colin Green
- Health Economics Group, University of Exeter College of Medicine and Health, University of Exeter, Exeter, UK.
| | - Ron Handels
- Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, Maastricht, The Netherlands; Division of Neurogeriatrics, Department for Neurobiology, Care Sciences and Society, Karolinska Institute, Solna, Sweden
| | - Anders Gustavsson
- Division of Neurogeriatrics, Department for Neurobiology, Care Sciences and Society, Karolinska Institute, Solna, Sweden; Quantify Research, Stockholm, Sweden
| | - Anders Wimo
- Division of Neurogeriatrics, Department for Neurobiology, Care Sciences and Society, Karolinska Institute, Solna, Sweden
| | - Bengt Winblad
- Division of Neurogeriatrics, Department for Neurobiology, Care Sciences and Society, Karolinska Institute, Solna, Sweden; Theme Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Sköldunger
- Division of Neurogeriatrics, Department for Neurobiology, Care Sciences and Society, Karolinska Institute, Solna, Sweden
| | - Linus Jönsson
- Division of Neurogeriatrics, Department for Neurobiology, Care Sciences and Society, Karolinska Institute, Solna, Sweden; H. Lundbeck A/S, Copenhagen, Denmark
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Costs and Burden Associated With Loss of Labor Productivity in Informal Caregivers of People With Dementia: Results From Spain. J Occup Environ Med 2019; 60:449-456. [PMID: 29135840 DOI: 10.1097/jom.0000000000001229] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS We analyzed indirect costs related to loss of labor productivity (LLP) in informal caregivers (ICs) of people with dementia (PwD) and the associated caregiver burden and patients' clinical variables. METHODS Multicenter cohort study of PwD and their ICs (n = 287) focused on two groups: (1) home care and (2) institutional long-term care. The costs of LLP were assessed using the Resource Utilization Dementia instrument and a human capital approach. RESULTS The cost for LLP was 378&OV0556;/month or 4.536&OV0556;/year. Greater disease severity increased the likelihood of reducing working hours and missing a working day. There was a significant association between partial absenteeism and burden in employed informal caregiver in both the home and institutional setting. CONCLUSION Cognitive impairment contributes to the cost of LLP in IC especially in home-care. LLP has a negative impact on IC burden.
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Rashedi V, Foroughan M, Nazari H, Seeher K, Brodaty H. Validity and reliability of the Persian version of general practitioner assessment of cognition (P-GPCOG). Aging Ment Health 2019; 23:961-965. [PMID: 29781711 DOI: 10.1080/13607863.2018.1473840] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objectives: The study aimed to examine the validity, reliability, and practicality of the Persian version of the General Practitioner Assessment of Cognition (P-GPCOG) as a brief, efficient cognitive assessment instrument in Iranian older adults. Method: The sample comprised 151 community-dwelling older adults and 79 nursing home residents (aged ≥60 years). The English GPCOG was translated, back-translated, and revised to prepare the final P-GPCOG. The Abbreviated Mental Test score (AMTs) and the Depression in Old Age Scale (DIA-S) were administered to the two different samples to establish the convergent and discriminant validity of the P-GPCOG. Results: The mean age of the sample was 70.67 (SD = 9.51); 57.4% were male. The mean P-GPCOG scores for the total, cognitive and informant subscales were 7.67 (SD = 4.59), 4.18 (SD = 2.73), and 3.49 (SD = 2.24), respectively. Cognitive (P < 0.001), informant (P < 0.001) and total scores (P < 0.001) differed significantly between community-dwelling participants and nursing home residents. Worse cognitive performance on the P-GPCOG correlated significantly with worse scores on the AMTs (r = 0.61, P < 0.001) and less so with depressive symptoms as measured with the DIA-S (r = -0.20, P < 0.05). Cronbach's alpha for the P-GPCOG cognitive and informant subscales were 0.90 and 0.83 respectively, indicating a high degree of internal consistency and homogeneity between items. The test-retest correlation for the total P-GPCOG score was 0.82 in 30 participants after 19 days. P-GPCOG cognitive scores correlated significantly with education. Conclusion: The P-GPCOG displayed strong psychometric properties, offering healthcare professionals a quick and efficient cognitive instrument for older Persian speakers. As with other cognitive assessment tools, the P-GPCOG cognitive score is affected by a person's level of education.
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Affiliation(s)
- Vahid Rashedi
- a Tehran Psychiatric Institute, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences , Tehran , Iran
| | - Mahshid Foroughan
- b Iranian Research Center On Aging , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran
| | - Heiman Nazari
- c Student Research Committee , Hamadan University of Medical Sciences & Health Services , Hamadan , Iran
| | - Katrin Seeher
- d Dementia Collaborative Research Centre , School of Psychiatry, University of New South Wales , Sydney , Australia
| | - Henry Brodaty
- d Dementia Collaborative Research Centre , School of Psychiatry, University of New South Wales , Sydney , Australia.,e Centre For Healthy Brain Ageing , School of Psychiatry, University of New South Wales , Sydney , Australia
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Hermans S, Sevenants A, Declercq A, Broeck NV, Deliens L, Cohen J, Audenhove CV. Inter-organisational collaboration in palliative care trajectories for nursing home residents: A nation-wide mixed methods study among key persons. INTERNATIONAL JOURNAL OF CARE COORDINATION 2019. [DOI: 10.1177/2053434519857352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Multiple care organisations, such as home care services, nursing homes and hospitals, are responsible for providing an appropriate response to the palliative care needs of older people admitted into long-term care facilities. Integrated palliative care aims to provide seamless and continuous care. A possible organisational strategy to help realise integrated palliative care for this population is to create a network in which these organisations collaborate. The aim is to analyse the collaboration processes of the various organisations involved in providing palliative care to nursing home residents. Method A sequential mixed-methods study, including a survey sent to 502 participants to evaluate the collaboration between home and residential care, and between hospital and residential care, and additionally three focus group interviews involving a purposive selection among the survey participants. Participants are key persons from the nursing homes, hospitals and home care organisations that are part of the 15 Flemish palliative care networks dispersed throughout the region of Flanders, Belgium. Results Survey data were gathered from 308 key persons (response rate: 61%), and 16 people participated in three focus group interviews. Interpersonal dimensions of collaboration are rated higher than structural dimensions. This effect is statistically significant. Qualitative analyses identified guidelines, education, and information-transfer as structural challenges. Additionally, for further development, members should become acquainted and the network should prioritise the establishment of a communication infrastructure, shared leadership support and formalisation. Discussion The insights of key persons suggest the need for further structuration and can serve as a guideline for interventions directed at improving inter-organisational collaboration in palliative care trajectories for nursing home residents.
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Affiliation(s)
| | | | | | | | - Luc Deliens
- Vrije Universiteit Brussel (VUB), Belgium
- Ghent University, Belgium
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[Care planning for people with dementia on the margins of care between home care and nursing home: the balance of care approach in the RightTimePlaceCare project in Germany]. Z Gerontol Geriatr 2019; 52:751-757. [PMID: 30770992 DOI: 10.1007/s00391-019-01510-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 01/09/2019] [Accepted: 01/17/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND The balance of care approach is a strategic planning framework that can be used to research the adequacy of care arrangements and the cost implications. It seeks to identify people who are on the margins of care, i. e. whose care and nursing needs could be met in more than one setting, and explores the relative costs of the possible alternatives. This article describes a balance of care application for people with dementia in a transitional phase between home and institutional care in Germany. METHODS A sequential mixed-methods design was applied that combined empirical data, the decision of healthcare professionals (panels) and cost estimates in a structured way. Data were collected as part of the RightTimePlaceCare project from 235 people with dementia and their caregivers in 2 settings, in nursing homes and domestic care. RESULTS Based on five key variables, case types of people with dementia with comparable needs were developed. In panels with healthcare professionals there was consensus that people represented by four of these case types could by cared for at home while the reference group of actual study participants was currently being cared for in nursing homes. For these four case types, exemplary home care arrangements were formulated, costs were estimated and compared to institutional care costs. CONCLUSION There is a potential for home care for a significant group of people with dementia currently admitted to institutional care. Some of the alternative home care arrangements were cost-saving. Despite some limitations, the study demonstrated the utility of the balance of care approach to support the development of empirically based expert recommendations on care provision.
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van Lier LI, van der Roest HG, Oosten BS, Garms-Homolová V, Onder G, Finne-Soveri H, V Jónsson P, Ljunggren G, Henrard JC, Topinkova E, Sørbye LW, Bernabei R, van Hout HP, Bosmans JE. Predictors of Societal Costs of Older Care-Dependent Adults Living in the Community in 11 European Countries. Health Serv Insights 2019; 12:1178632918820947. [PMID: 30718960 PMCID: PMC6348544 DOI: 10.1177/1178632918820947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 11/15/2018] [Indexed: 11/22/2022] Open
Abstract
Background: The objective was to identify predictors of societal costs covering formal and informal care utilization by older home care clients in 11 European countries. Methods: Societal costs of 1907 older clients receiving home care for 12 months from the Aged in Home care (AdHoc) study were estimated using the InterRAI Minimum Data Set for Home Care’s (MDS-HC) resource use items. Predictors (medical, functional, and psychosocial domains) of societal costs were identified by performing univariate and multivariate generalized linear model analyses. Results: Mean societal costs per participant were €36 442, ranging from €14 865 in Denmark to €78 836 in the United Kingdom. In the final multivariate model, country, being married, activities of daily living (ADL) dependency, cognitive impairment, limitations of going out, oral conditions, number of medications, arthritis, and cerebro vascular accident (CVA) were significantly associated with societal costs. Conclusions: Of the predictors, ADL dependency and limitations of going out may be modifiable. Developing interventions targeted at improving these conditions may create opportunities to curtail societal costs.
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Affiliation(s)
- Lisanne I van Lier
- Department of General Practice & Elderly care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Henriëtte G van der Roest
- Department of General Practice & Elderly care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Babette Sh Oosten
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, The Netherlands
| | - Vjenka Garms-Homolová
- Department III, Economy and Law, Hochschule für Technik und Wirtschaft Berlin, Berlin, Germany
| | - Graziano Onder
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Harriet Finne-Soveri
- Department of Wellbeing, National Institute for Health and Welfare, Helsinki, Finland.,Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Pálmi V Jónsson
- Icelandic Gerontologica Research Institute, Landspitali University Hospital, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Gunnar Ljunggren
- Public Healthcare Services Committee Administration, Stockholm County Council, Sweden.,Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden
| | - Jean-Claude Henrard
- Laboratoire Universitaire Santé-Environment-Vieillissement, Versailles Saint-Quentin-en-Yvelines (UVSQ) University, Paris, France
| | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czech Republic
| | | | - Roberto Bernabei
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Hein Pj van Hout
- Department of General Practice & Elderly care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Judith E Bosmans
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, The Netherlands
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Ruiz Fernández MD, Ortega Galán ÁM. Evaluation of the perceived health of caregivers of patients in mild-to-moderate stage Alzheimer's disease. Perspect Psychiatr Care 2019; 55:87-94. [PMID: 29969153 DOI: 10.1111/ppc.12306] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/18/2018] [Accepted: 06/09/2018] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To know the health perceived by the family caregivers of Alzheimer's disease, according to the relationship of kinship and the duration of the care in mild-to-moderate stage of dementia. DESIGN AND METHODS Cross-sectional descriptive study in 255 caregivers. The instruments used were an ad hoc questionnaire and the Goldberg General Health Questionnaire (GHQ-28). FINDINGS The presence of acute and chronic mental pathology has been observed. Specifically in the spouses and children, severe depression and social dysfunction, and in periods of care between 2 and 5 years, mainly anxiety and insomnia have been observed. PRACTICE IMPLICATIONS The relationship of kinship and the duration of care must be taken into account in the planning of specific interventions in these caregivers.
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Singh NA, Bhardwaj V, Ravi C, Ramesh N, Mandal AKA, Khan ZA. EGCG Nanoparticles Attenuate Aluminum Chloride Induced Neurobehavioral Deficits, Beta Amyloid and Tau Pathology in a Rat Model of Alzheimer's Disease. Front Aging Neurosci 2018; 10:244. [PMID: 30150930 PMCID: PMC6099078 DOI: 10.3389/fnagi.2018.00244] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/24/2018] [Indexed: 02/05/2023] Open
Abstract
Rational: Alzheimer's disease (AD) is a neurodegenerative pathology characterized by the presence of neuritic plaques and neurofibrillary tangles. Aluminum has been reported to play an important role in the etiology and pathogenesis of this disease. Hence, the present study aimed to evaluate the neuroprotective role of epigallocatechin-gallate (EGCG) loaded nanoparticles (nanoEGCG) against aluminum chloride (AlCl3) induced neurobehavioral and pathological changes in AD induced rats. Method: 100 mg/kg body weight AlCl3 was administered orally for 60 days, which was followed by 10 mg/kg body weight free EGCG and nanoEGCG treatment for 30 days. Morris water maze, open field and novel object recognition tests were employed for neurobehavioral assessment of the rats. This was followed by histopathological assessment of the cortex and the hippocampus in the rat brain. For further validation biochemical, immunohistochemistry and western blot assays were carried out. Result: Aluminum exposure reduced the exploratory and locomotor activities in open field and significantly reduced the memory and learning curve of rats in Morris water maze and novel object recognition tests. These neurobehavioral impairments were significantly attenuated in nanoEGCG treated rats. Histopathological assessment of the cortex and hippocampus of AlCl3 induced rat brains showed the presence of both neuritic plaques and neurofibrillary tangles. In nanoEGCG treated rats this pathology was absent. Significant increase in biochemical, immunohistochemical and protein levels was noted in AlCl3 induced rats. While these levels were greatly reduced in nanoEGCG treated rats. Conclusion: In conclusion, this study strengthens the hypothesis that EGCG nanoparticles can reverse memory loss, neuritic plaque and neurofibrillary tangles formation.
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Affiliation(s)
- Neha Atulkumar Singh
- Department of Integrative Biology, School of Biosciences and Technology, Vellore Institute of Technology, Vellore, India
| | - Vaishali Bhardwaj
- Department of Biotechnology, School of Biosciences and Technology, Vellore Institute of Technology, Vellore, India
| | - Chandrika Ravi
- Department of Biotechnology, School of Biosciences and Technology, Vellore Institute of Technology, Vellore, India
| | - Nithya Ramesh
- Department of Biotechnology, School of Biosciences and Technology, Vellore Institute of Technology, Vellore, India
| | - Abul Kalam Azad Mandal
- Department of Biotechnology, School of Biosciences and Technology, Vellore Institute of Technology, Vellore, India
| | - Zaved Ahmed Khan
- University Institute of Biotechnology, Chandigarh University, Mohali, India
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Blanco-Silvente L, Capellà D, Garre-Olmo J, Vilalta-Franch J, Castells X. Predictors of discontinuation, efficacy, and safety of memantine treatment for Alzheimer's disease: meta-analysis and meta-regression of 18 randomized clinical trials involving 5004 patients. BMC Geriatr 2018; 18:168. [PMID: 30041625 PMCID: PMC6057050 DOI: 10.1186/s12877-018-0857-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 07/09/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The risk-benefit relationship of memantine treatment for Alzheimer's disease (AD) remains unclear. In addition, variability between the results of clinical trials has been observed. The aim of this study was to investigate the risk-benefit relationship of memantine treatment in patients with AD and to determine the predictor effect of patient, intervention, and study design related covariates. METHODS A systematic review and meta-analysis of double-blind, placebo controlled clinical trials was performed. Primary outcomes were all-cause discontinuation, discontinuation due to adverse events (AE) and efficacy on cognitive function. Odds ratio (OR) and standard mean difference (SMD) with 95% confidence intervals were calculated. Meta-regression was conducted to identify related covariates. Cochrane Collaboration tool was used to evaluate the risk of bias of included trials. RESULTS Eighteen studies involving 5004 patients were included. No differences between memantine and placebo were found for all-cause treatment discontinuation (OR=0.97 [0.82, 1.14]) and discontinuation due to AE (OR=1.18 [0.91, 1.53]). Memantine showed small improvement on cognitive function (SMD=0.15 [0.08, 0.22]). Baseline functional ability was positively associated with all-cause treatment discontinuation and discontinuation due to AE. CONCLUSIONS Our study suggests that memantine has a very small efficacy on AD symptomatology and its safety profile is similar to that of placebo. No evidence of treatment discontinuation improvement with memantine is found, indicating a dubious risk-benefit relationship. No intervention characteristic or subgroup of patients clearly shows a significantly better risk-benefit relationship. PROSPERO REGISTRATION CRD42014015696 .
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Affiliation(s)
- Lídia Blanco-Silvente
- TransLab Research Group; Department of Medical Sciences, University of Girona, Girona, Spain
- Department of Medical Sciences, Faculty of Medicine, University of Girona, Emili Grahit, 77, 17003 Girona, Spain
| | - Dolors Capellà
- TransLab Research Group; Department of Medical Sciences, University of Girona, Girona, Spain
- Department of Medical Sciences, Faculty of Medicine, University of Girona, Emili Grahit, 77, 17003 Girona, Spain
| | - Josep Garre-Olmo
- Department of Medical Sciences, Faculty of Medicine, University of Girona, Emili Grahit, 77, 17003 Girona, Spain
- Girona Biomedical Research Institute (IdibGi), Parc Hospitalari Martí i Julià, Salt, Spain
| | - Joan Vilalta-Franch
- Department of Medical Sciences, Faculty of Medicine, University of Girona, Emili Grahit, 77, 17003 Girona, Spain
- Girona Biomedical Research Institute (IdibGi), Parc Hospitalari Martí i Julià, Salt, Spain
| | - Xavier Castells
- TransLab Research Group; Department of Medical Sciences, University of Girona, Girona, Spain
- Department of Medical Sciences, Faculty of Medicine, University of Girona, Emili Grahit, 77, 17003 Girona, Spain
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Montgomery W, Goren A, Kahle-Wrobleski K, Nakamura T, Ueda K. Alzheimer's disease severity and its association with patient and caregiver quality of life in Japan: results of a community-based survey. BMC Geriatr 2018; 18:141. [PMID: 29898679 PMCID: PMC6000944 DOI: 10.1186/s12877-018-0831-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 05/29/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Alzheimer's disease (AD) dementia, a progressive neurodegenerative disease, exerts significant burden upon patients, caregivers, and healthcare systems globally. The current study investigated the associations between AD dementia patient disease severity and health-related quality of life (HRQoL) of both patients (proxy report) and their caregivers living in Japan, as well as caregiving-related comorbidities such as depression. METHODS This cross-sectional study used self-reported data from caregivers of people diagnosed with AD dementia by a healthcare provider in Japan. Caregivers were identified via online panels and invited to participate in an online survey between 2014 and 2015. Caregivers completed survey items for themselves, in addition to providing proxy measures for patients with AD dementia for whom they were caring. Patient and caregiver HRQoL was measured using the EuroQoL 5-Dimension (EQ-5D). Additional outcomes for caregivers of AD dementia patients included the Patient Health Questionnaire (PHQ-9) of depressive symptomology, as well as comorbidities experienced since initiating caregiving for their AD dementia patients. These outcomes were examined as a function of AD dementia severity, as measured by long-term care insurance (LTCI) categories. Bivariate analyses between LTCI and outcomes were conducted using independent t-tests and chi-square tests. Multivariable analyses, controlling for potential confounders, were conducted using generalized linear models (GLMs) specifying a normal distribution. RESULTS Across 300 caregiver respondents, multivariable results revealed that increasing AD dementia severity was significantly associated with poorer patient and caregiver EQ-5D scores and a high proportion of caregivers (30.0%) reported PHQ-9 scores indicative of major depressive disorder (MDD). The most frequent comorbidities experienced after becoming caregivers of AD dementia patients included hypertension (12.7%) and insomnia (11.0%). Depression and other comorbidities did not differ significantly by patient severity. CONCLUSIONS The current study provides unique insight into the specific degree of incremental burden associated with increasing AD dementia severity among patients and caregivers alike. Importantly, greater disease severity was associated with poorer quality of life among both patients and caregivers. These results suggest that earlier detection and treatment of AD dementia may provide an opportunity to reduce the burden of disease for patients, caregivers, and society at large.
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Affiliation(s)
- William Montgomery
- Global Patient Outcomes & Real World Evidence, Eli Lilly Australia, 112 Wharf Rd, West Ryde, NSW 2114 Australia
| | - Amir Goren
- Health Outcomes Practice, Kantar Health, 11 Madison Ave, Floor 12, New York, NY 10010 USA
| | - Kristin Kahle-Wrobleski
- Global Patient Outcomes & Real World Evidence, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285 USA
| | - Tomomi Nakamura
- Medical Development Unit, Eli Lilly Japan K.K, 4-15-1, Akasaka, Minato-ku, Tokyo, 107-0052 Japan
| | - Kaname Ueda
- Health Outcomes, Health Technology Assessment, & Real World Evidence, Medical Development Unit, Eli Lilly Japan K.K, 5-1-28, Isogami-dori, chuou-ku, Kobe, 651-0086 Japan
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Koskas P, Pons-Peyneau C, Romdhani M, Houenou-Quenum N, Tigue-Wato A, Galleron S, Drunat O. Effectiveness of multidisciplinary consultation for older adults with Alzheimer's disease in response to acute situations. Encephale 2018; 44:491-495. [PMID: 29887303 DOI: 10.1016/j.encep.2018.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 01/23/2018] [Accepted: 01/26/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND To avoid emergency hospitalisation of elderly people with dementia, which often has negative consequences, there are two main approaches: consultation and day care hospitalisation. However, it usually takes some time to arrange a consultation, and geriatric day hospital facilities are over-subscribed and costly. In 2014, we created a "consultation de crise" (CMC) programme in our sector of Paris, with several special features: a short wait for an appointment, a consultation involving an interdisciplinary team, a weekly multi-disciplinary meeting to reassess complex patients, and the possibility of a rapid referral to a social worker. METHODS To determine whether the CMC programme is a useful way to minimise hospitalization among elderly community-dwelling populations, and to examine its design criteria. Retrospective review of all CMC requests from April 2014 to January 2017 in comparison with consultation at the Memory Center and geriatric day hospital. CMC patients were followed up at one month after their assessment. RESULTS Mini Mental Status and Neuro Psychiatric Inventory vary significantly different between the 3 groups. The CMC group had the lowest score on the MMSE scale and the highest for NPI. After one month, 60% of CMC patients were still at home (33 patients) or in the same nursing home (6 patients) and about 23% were hospitalized during the follow-up period. CONCLUSION Our study showed the potential value of a less expensive multidisciplinary consultation, and confirmed that collaborative care resulted in a significant improvement in the quality of care.
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Affiliation(s)
- P Koskas
- Memory Center, Bretonneau Hospital, Assistance Publique-Hôpitaux de Paris, 23, rue Joseph-de-Maistre 75018 Paris, France.
| | - C Pons-Peyneau
- Department of Psycho-Geriatrics, Bretonneau Hospital, Assistance Publique-Hôpitaux de Paris, 23, rue Joseph-de-Maistre 75018 Paris, France
| | - M Romdhani
- Department of Psycho-Geriatrics, Bretonneau Hospital, Assistance Publique-Hôpitaux de Paris, 23, rue Joseph-de-Maistre 75018 Paris, France
| | - N Houenou-Quenum
- Department of Psycho-Geriatrics, Bretonneau Hospital, Assistance Publique-Hôpitaux de Paris, 23, rue Joseph-de-Maistre 75018 Paris, France
| | - A Tigue-Wato
- Department of Psycho-Geriatrics, Bretonneau Hospital, Assistance Publique-Hôpitaux de Paris, 23, rue Joseph-de-Maistre 75018 Paris, France
| | - S Galleron
- Department of Psycho-Geriatrics, Bretonneau Hospital, Assistance Publique-Hôpitaux de Paris, 23, rue Joseph-de-Maistre 75018 Paris, France
| | - O Drunat
- Department of Psycho-Geriatrics, Bretonneau Hospital, Assistance Publique-Hôpitaux de Paris, 23, rue Joseph-de-Maistre 75018 Paris, France
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Rapp T, Andrieu S, Chartier F, Deberdt W, Reed C, Belger M, Vellas B. Resource Use and Cost of Alzheimer's Disease in France: 18-Month Results from the GERAS Observational Study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:295-303. [PMID: 29566836 DOI: 10.1016/j.jval.2017.09.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 09/13/2017] [Accepted: 09/28/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND There is little longitudinal data on resource use and costs associated with Alzheimer's disease (AD) in France. OBJECTIVES To evaluate resource use and societal costs associated with AD in a French cohort of patients and their caregivers and the effect of patient cognitive decline on costs over an 18-month period. METHODS Community-dwelling patients with mild, moderate, or moderately severe/severe AD dementia (n = 419) were followed-up for 18 months. Total societal costs were estimated by applying 2010 unit costs to resource use, including outpatient visits, hospital days, institutionalization, and caregiver hours. Cognitive function was assessed by Mini-Mental State Examination scores. RESULTS Mean cumulative total costs over the 18-month period were €24,140 for patients with mild AD dementia, €34,287 for those with moderate AD dementia, and €44,171 for those with moderately severe/severe AD dementia (P < 0.001; ANOVA comparison between severity groups). The biggest contributor to total societal costs was caregiver informal care (>50% of total costs at all stages of AD dementia). Cognitive decline (≥3-point decrease in Mini-Mental State Examination score or institutionalization) was associated with a 12.5% increase in total costs (P = 0.02). Significant differences were observed across severity groups for caregiver time (P < 0.001); mean monthly caregiver time increased at each time point over the 18 months in each severity group. CONCLUSIONS Increasing severity of AD dementia in France is associated with increased use of resources as well as increased total societal and patient costs; informal care was the greatest cost contributor. Clinically meaningful cognitive decline is associated with significantly increased costs.
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Affiliation(s)
- Thomas Rapp
- LIRAES (EA4470), Université Paris Descartes-Sorbonne Paris Cité, Paris, France.
| | | | | | | | - Catherine Reed
- Eli Lilly and Company, Lilly Research Centre, Windlesham, UK
| | - Mark Belger
- Eli Lilly and Company, Lilly Research Centre, Windlesham, UK
| | - Bruno Vellas
- Gerontopole, INSERM UMR1027, Toulouse University Hospital, Toulouse, France
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Abstract
The objective of this study was to evaluate the use of antidementia drugs (ADDs) in patients with Alzheimer's disease (AD) regarding German guideline recommendations and to assess correlations between the use of ADDs and the patients' characteristics. A total of 395 community-dwelling and institutionalized patients with AD across all severity stages of dementia were recruited in this cross-sectional study. Associations between the prescription of ADDs and patients' sociodemographic and clinical parameters (neuropsychiatric symptoms, cognitive capacity, daily activities, and health-related quality of life) were analyzed in multiple logistic regression analyses. ADDs were prescribed in 46.6% of all participants and less often in institutionalized patients (38.2 vs. 50.4%, P=0.025). Patients with mild-to-moderate dementia had a higher chance of receiving ADDs [odds ratio (OR)=3.752, 95% confidence interval (CI): 1.166-12.080 and OR=3.526, 95% CI: 1.431-8.688] as well as those treated by neurologists/psychiatrists (OR=2.467, 95% CI: 1.288-4.726). Overall, 39% of the patients with mild cognitive deficits (Mini-Mental Status Examination 27-30) received ADDs and 21% of the mildly demented patients (Mini-Mental Status Examination 20-26) received memantine. The treatment with ADDs was in part not in line with German guideline recommendations. Particularly, the lower use of ADDs in patients not attending neuropsychiatric specialists should be further evaluated.
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Treatment effects of Ginkgo biloba extract EGb 761® on the spectrum of behavioral and psychological symptoms of dementia: meta-analysis of randomized controlled trials. Int Psychogeriatr 2018; 30:285-293. [PMID: 28931444 DOI: 10.1017/s1041610217001892] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
UNLABELLED ABSTRACTBackground:In randomized controlled trials, Ginkgo biloba extract EGb 761® has been found to be effective in the treatment of behavioral and psychological symptoms of dementia (BPSD). METHODS To assess the effects of EGb 761® on specific BPSD, we analyzed data from all randomized, placebo-controlled, at least 20-week, trials of EGb 761® enrolling patients with dementia (probable Alzheimer's disease (AD), probable vascular dementia or probable AD with cerebrovascular disease) who had clinically significant BPSD (Neuropsychiatric Inventory (NPI) total score at least 6). Data were pooled and joint analyses of NPI single item composite and caregiver distress scores were performed by meta-analysis with a fixed effects model. RESULTS Four trials involving 1628 patients (EGb 761®, 814; placebo, 814) were identified; treatment duration was 22 or 24 weeks; the daily dose of EGb 761® was 240 mg in all trials. Pooled analyses including data from the full analysis sets of all trials (EGb 761®, 796 patients; placebo, 802 patients) revealed significant superiority of EGb 761® over placebo in total scores and 10 single symptom scores. Regarding caregiver distress scores, EGb 761®-treated patients improved significantly more than those receiving placebo in all symptoms except delusions, hallucinations, and elation/euphoria. The benefit of EGb 761® mainly consists of improvement in symptoms present at baseline, but the incidence of some symptoms was also decreased. CONCLUSIONS Twenty two- to twenty four-week treatment with Ginkgo biloba extract EGb 761® improved BPSD (except psychotic-like features) and caregiver distress caused by such symptoms.
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Costa N, Wübker A, De Mauléon A, Zwakhalen SM, Challis D, Leino-Kilpi H, Hallberg IR, Stephan A, Zabalegui A, Saks K, Molinier L, Wimo A, Vellas B, Sauerland D, Binot I, Soto ME, Meyer G, Stephan A, Renom Guiteras A, Sauerland D, Wübker A, Bremer P, Hamers JP, Afram B, Beerens HC, Bleijlevens MH, Verbeek H, Zwakhalen SM, Ruwaard D, Rahm Hallberg I, Emilsson UM, Karlsson S, Challis D, Sutcliffe C, Jolley D, Tucker S, Bowns I, Roe B, Burns A, Leino-Kilpi H, Koskenniemi J, Suhonen R, Viitanen M, Arve S, Stolt M, Hupli M, Saks K, Tiit EM, Leibur J, Raamat K, Armolik A, Marjatta Toivari TT, Zabalegui A, Navarro M, Cabrera E, Risco E, Soto M, Milhet A, Sourdet S, Gillette S, Vellas B. Costs of Care of Agitation Associated With Dementia in 8 European Countries: Results From the RightTimePlaceCare Study. J Am Med Dir Assoc 2018; 19:95.e1-95.e10. [DOI: 10.1016/j.jamda.2017.10.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 10/12/2017] [Indexed: 10/18/2022]
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Holmerová I, Hort J, Rusina R, Wimo A, Šteffl M. Costs of dementia in the Czech Republic. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2017; 18:979-986. [PMID: 27785577 DOI: 10.1007/s10198-016-0842-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 10/18/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The aim of this study was to estimate the cost of dementia in the Czech Republic. METHODS One hundred and nineteen patient-caregiver dyads participated in our multicenter observational cost-of-illness study. The modified Resource Utilization in Dementia Questionnaire was used as the main tool to collect data from patients and caregivers. Medical specialists provided additional data from medical records. The average costs of dementia were calculated and patients were then divided by the level of cognitive impairment. A generalized linear model was used to determine if differences were present for selected cost variables. RESULTS The mean (standard deviation) for direct cost per a patient in a month was estimated to be €243.0 (138.0), €1727.1 (1075.6) for the indirect cost, and €1970.0 (1090.3) for the total cost of dementia in the Czech Republic. All of the costs increased as dementia severity increased. Both the indirect and total costs significantly (p < 0.05) increased if patients were living with their primary caregiver, and if the severity of cognitive impairment was increased. CONCLUSIONS The indirect cost, which was represented mainly by informal care, comprised the main part of the total cost of care for patients with dementia in the Czech Republic. Both total and indirect care costs increased significantly the cognition declined.
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Affiliation(s)
- Iva Holmerová
- Faculty of Humanities, Centre of Expertise Longevity and Long Term Care and Centre of Gerontology, Charles University Prague, Prague, Czech Republic
| | - Jakub Hort
- Department of Neurology, Faculty of Medicine 2, Memory Clinic, Charles University Prague, Prague, Czech Republic
| | - Robert Rusina
- Department of Neurology, Faculty of Medicine 1, Charles University Prague, Prague, Czech Republic
| | - Anders Wimo
- Division of Neurogeriatrics, Department of Neurobiology Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Huddinge, Sweden
| | - Michal Šteffl
- Faculty of Physical Education and Sport, Charles University Prague, Veleslavin, 16252 6, Prague, Czech Republic.
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Use of psychotropic medications in relation to neuropsychiatric symptoms, cognition and functional performance in Alzheimer's disease over a three-year period: Kuopio ALSOVA study. Int Psychogeriatr 2017. [PMID: 28625207 DOI: 10.1017/s1041610217001090] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Psychotropic medications are widely prescribed to manage neuropsychiatric symptoms (NPS) of Alzheimer's disease (AD). Our objective was to investigate the longitudinal associations between psychotropic medication use and NPS, cognition, and functional performance in persons with very mild or mild AD at baseline. METHODS Data were collected as part of the prospective three-year study of home-dwelling persons with AD and their caregivers (n = 236 dyads). The associations between psychotropic medication use and clinical measures were analyzed using repeated measures Generalized Estimating Equation (GEE) models. NPS, cognition, daily functioning, and disease severity were assessed with NPI, CERAD-NB, or MMSE, ADCS-ADL, and CDR-SOB, respectively. All analyses were adjusted for age, gender, education, and co-morbidities. RESULTS The prevalence of benzodiazepines and related medications increased from 16% to 24% (p = 0.031), antidepressants from 11% to 18% (p = 0.057), and antipsychotics from 4% to 16% (p = 0.011) in the three years following AD diagnosis. In adjusted multivariable analyses, a one-point increase in NPI increased the odds of using any psychotropic medication class by 4% (odds ratio (OR) 1.04, 95% confidence interval (CI) 1.01-1.07). ADCS-ADL (1/OR 1.04, 95% CI 1.02-1.06) and CDR-SOB (OR 1.27, 95% CI 1.13-1.42) were associated with use of antipsychotics. CERAD-NB and MMSE were not associated with any psychotropic medication class use in the models. CONCLUSIONS Psychotropic medication use increased significantly in relation to increasing dependency in AD, especially with NPS. Furthermore, the use of antipsychotics increased with disease severity, and with decline in daily functioning. Cognitive performance was not associated with psychotropic medication use.
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Lacey L, Bobula J, Niecko T, Leibman C. Informal Care Time and Cost in a Large Clinical Trial Sample of Patients with Mild to Moderate Alzheimer's Disease: Determinants and Level of Change Observed. Neurol Ther 2017; 6:11-23. [PMID: 27878522 PMCID: PMC5447549 DOI: 10.1007/s40120-016-0056-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION We evaluate the association between caregiver (informal) time/cost and illness severity from two recently completed clinical trials of an investigational drug for Alzheimer's disease (AD). METHODS Changes from baseline caregiver time were calculated and treatment effects analyzed using a restricted maximum likelihood-based mixed model for repeated measures. Four separate models were then estimated to examine the association between caregiver time costs and the clinical endpoints measured during the trials, including cognition (MMSE), function (DAD), behavior (NPI), global disability (CDR) and dependence (DS). RESULTS Caregiver time cost was significantly associated with all clinical measures of illness severity with a 1-unit change in MMSE, DAD, NPI, CDR and DS associated with a 11.57%, 4.81-4.97%, 3.58-3.67%, 42.52% and 71.05% change, respectively, in primary caregiver time cost. The association between caregiver time cost and DS was the strongest of all the associations examined. CONCLUSION Caregiver time costs increase with increasing AD severity in all key domains of AD (cognition, function, behavior, global disability and dependence on others). Our analysis demonstrated that patient dependence is a particularly important predictor of caregiver time costs and should be considered as a potential outcome measure in intervention clinical trials in AD. FUNDING Pfizer Inc. and Janssen Alzheimer Immunotherapy Research and Development.
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Affiliation(s)
- Loretto Lacey
- Lacey Solutions, Ltd., The Beaches, South Strand, Skerries, Dublin, Ireland
| | - Joel Bobula
- Pfizer Inc., 500 Arcola Road, Collegeville, PA, 19426, USA.
| | - Timothy Niecko
- Niecko Health Economics, LLC, 275 Indies Way, Naples, FL, 34110, USA
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Jones RW, Lebrec J, Kahle-Wrobleski K, Dell'Agnello G, Bruno G, Vellas B, Argimon JM, Dodel R, Haro JM, Wimo A, Reed C. Disease Progression in Mild Dementia due to Alzheimer Disease in an 18-Month Observational Study (GERAS): The Impact on Costs and Caregiver Outcomes. Dement Geriatr Cogn Dis Extra 2017; 7:87-100. [PMID: 28611822 PMCID: PMC5465649 DOI: 10.1159/000461577] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 12/13/2016] [Indexed: 01/16/2023] Open
Abstract
Background/Aims We assessed whether cognitive and functional decline in community-dwelling patients with mild Alzheimer disease (AD) dementia were associated with increased societal costs and caregiver burden and time outcomes. Methods Cognitive decline was defined as a ≥3-point reduction in the Mini-Mental State Examination and functional decline as a decrease in the ability to perform one or more basic items of the Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory (ADCS-ADL) or ≥20% of instrumental ADL items. Total societal costs were estimated from resource use and caregiver hours using 2010 costs. Caregiver burden was assessed using the Zarit Burden Interview (ZBI); caregiver supervision and total hours were collected. Results Of 566 patients with mild AD enrolled in the GERAS study, 494 were suitable for the current analysis. Mean monthly total societal costs were greater for patients showing functional (+61%) or cognitive decline (+27%) compared with those without decline. In relation to a typical mean monthly cost of approximately EUR 1,400 at baseline, this translated into increases over 18 months to EUR 2,254 and 1,778 for patients with functional and cognitive decline, respectively. The number of patients requiring supervision doubled among patients showing functional or cognitive decline compared with those not showing decline, while caregiver total time increased by 70 and 33%, respectively and ZBI total score by 5.3 and 3.4 points, respectively. Conclusion Cognitive and, more notably, functional decline were associated with increases in costs and caregiver outcomes in patients with mild AD dementia.
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Affiliation(s)
- Roy W Jones
- aRICE (The Research Institute for the Care of Older People), Royal United Hospital, Bath, UK
| | | | | | | | - Giuseppe Bruno
- eDepartment of Neurology and Psychiatry, Clinica della Memoria, University of Rome "Sapienza", Rome, Italy
| | - Bruno Vellas
- fGerontopole, Toulouse University Hospital, INSERM 1027, Toulouse, France
| | - Josep M Argimon
- gDivisió d'Avaluació, Catalan Health Service, Barcelona, Spain
| | - Richard Dodel
- hDepartment of Neurology, Philipps University, Marburg, Germany
| | - Josep Maria Haro
- iParc Santari Saint Joan de Déu, CIBERSAM, University of Barcelona, Sant Boi de Llobregat, Barcelona, Spain
| | - Anders Wimo
- jDivision of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Catherine Reed
- kEli Lilly and Company Limited, Lilly Research Centre, Windlesham, UK
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