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Patient Dependence and Longitudinal Changes in Costs of Care in Alzheimer’s DiseaseZhu C.W.a, b · Leibman C.f · McLaughlin T.f · Zbrozek A.S.g · Scarmeas N.d, e · Albert M.h · Brandt J.h · Blacker D.i · Sano M.a, c · Stern Y.d, e
aGeriatric Research, Education, and Clinical Center (GRECC) and Research Enhancement Awards Program (REAP), James J. Peters VA Medical Center, Bronx, N.Y., bBrookdale Department of Geriatrics and cDepartment of Psychiatry, Mount Sinai School of Medicine, dCognitive Neuroscience Division, Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, and eGertrude H. Sergievsky Center and the Department of Neurology, Columbia University Medical Center, New York, N.Y., fElan Pharmaceuticals, Inc., San Francisco, Calif., gWyeth Pharmaceuticals, Collegeville, Pa., hDepartment of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Md., and iDepartment of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Mass., USA Corresponding Author
Carolyn W. Zhu
Geriatric Research, Education, and Clinical Center (GRECC)
James J. Peters VA Medical Center, 130 West Kingsbridge Road
Bronx, NY 10468 (USA)
Tel. +1 718 584 9000, ext. 3810, Fax +1 718 741 4211, E-Mail firstname.lastname@example.org
Background/Aims: To examine the incremental effect of patients’ dependence on others, on cost of medical and nonmedical care, and on informal caregiving hours over time. Methods: Data are obtained from 172 patients from the Predictors Study, a large, multicenter cohort of patients with probable Alzheimer disease (AD) followed annually for 4 years in 3 University-based AD centers in the USA. Enrollment required a modified Mini-Mental State Examination score ≧30. We examined the effects of patient dependence (measured by the Dependence Scale, DS) and function (measured by the Blessed Dementia Rating Scale, BDRS) on medical care cost, nonmedical care cost, and informal caregiving time using random effects regression models. Results: A one-point increase in DS score was associated with a 5.7% increase in medical cost, a 10.5% increase in nonmedical cost, and a 4.1% increase in caregiving time. A one-point increase in BDRS score was associated with a 7.6% increase in medical cost, a 3.9% increase in nonmedical cost and an 8.7% increase in caregiving time. Conclusions: Both functional impairment and patient dependence were associated with higher costs of care and caregiving time. Measures of functional impairment and patient dependence provide unique and incremental information on the overall impact of AD on patients and their caregivers.
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