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Vol. 26, No. 5, 2008
Issue release date: November 2008
Section title: Original Research Article
Free Access
Dement Geriatr Cogn Disord 2008;26:416–423
(DOI:10.1159/000164797)

Patient Dependence and Longitudinal Changes in Costs of Care in Alzheimer’s Disease

Zhu 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
email Corresponding Author

Abstract

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.

© 2008 S. Karger AG, Basel


  

Key Words

  • Alzheimer’s disease
  • Patient dependence
  • Costs of care, longitudinal changes

References

  1. Centers for Disease Control, National Center for Chronic Disease Prevention and Health Promotion: Unrealized Prevention Opportunities: Reducing the Health and Economic Burden of Chronic Illness. November 2000.
  2. Taylor DH Jr, Schenkman M, Zhou J, Sloan FA: The relative effect of Alzheimer’s disease and related dementias, disability, and comorbidities on cost of care for elderly persons. J Gerontol B Psychol Sci Soc Sci 2001;56:S285–S293.
  3. Small GW, McDonnell DD, Brooks RL, Papadopoulos G: The impact of symptom severity on the cost of Alzheimer’s disease. J Am Geriatr Soc 2002;50:321–327.
  4. Zhu CW, Scarmeas N, Torgan R, et al: Clinical characteristics and longitudinal changes of informal cost of Alzheimer’s disease in the community. J Am Geriatr Soc 2006;54:1596–1602.
  5. Zhu CW, Scarmeas N, Torgan R, et al: Longitudinal study of effects of patient characteristics on direct costs in Alzheimer disease. Neurology 2006;67:998–1005.
  6. Blessed G, Tomlinson BE, Roth M: The association between quantitative measures of dementia and of senile change in the cerebral grey matter of elderly subjects. Br J Psychiatry 1968;114:797–811.
  7. Stern Y, Albert SM, Sano M, et al: Assessing patient dependence in Alzheimer’s disease. J Gerontol 1994;49:M216–M222.
  8. Brickman AM, Riba A, Bell K, et al: Longitudinal assessment of patient dependence in Alzheimer disease. Arch Neurol 2002;59:1304–1308.
  9. Holtzer R, Tang MX, Devanand DP, et al: Psychopathological features in Alzheimer’s disease: course and relationship with cognitive status. J Am Geriatr Soc 2003;51:953–960.
  10. Sarazin M, Stern Y, Berr C, et al: Neuropsychological predictors of dependency in patients with Alzheimer disease. Neurology 2005;64:1027–1031.
  11. Murman DL, Von Eye A, Sherwood PR, Liang J, Colenda CC: Evaluated need, costs of care, and payer perspective in degenerative dementia patients cared for in the United States. Alzheimer Dis Assoc Disord 2007;21:39–48.
  12. Zhu CW, Leibman C, McLaughlin T, et al: The effects of patient function and dependence on costs of care in Alzheimer’s disease. J Am Geriatr Soc, in press.
  13. Stern Y, Folstein M, Albert M, et al: Multicenter study of predictors of disease course in Alzheimer disease (the ‘predictors study’). 1. Study design, cohort description, and intersite comparisons. Alzheimer Dis Assoc Disord 1993;7:3–21.
  14. Richards M, Folstein M, Albert M, et al: Multicenter study of predictors of disease course in Alzheimer disease (the ‘predictors study’). II. Neurological, psychiatric, and demographic influences on baseline measures of disease severity. Alzheimer Dis Assoc Disord 1993;7:22–32.
  15. Folstein MF, Folstein SE, McHugh PR: ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–198.
  16. Stern Y, Sano M, Paulson J, Mayeux R: Modified Mini-Mental State Examination: validity and reliability. Neurology 1987;37:179.

    External Resources

  17. Mirra SS: The CERAD neuropathology protocol and consensus recommendations for the postmortem diagnosis of Alzheimer’s disease: a commentary. Neurobiol Aging 1997;18:S91–S94.
  18. The National Institute on Aging, and Reagan Institute Working Group on Diagnostic Criteria for the Neuropathological Assessment of Alzheimer’s Disease: Consensus recommendations for the postmortem diagnosis of Alzheimer’s disease. Neurobiol Aging 1997;18:S1–S2.
  19. Leon J, Cheng CK, Neumann PJ: Alzheimer’s disease care: costs and potential savings. Health Aff (Millwood) 1998;17:206–216.
  20. Menzin J, Lang K, Friedman M, Neumann P, Cummings JL: The economic cost of Alzheimer’s disease and related dementias to the California Medicaid program (‘Medi-Cal’) in 1995. Am J Geriatr Psychiatry 1999;7:300–308.
  21. Charlson ME, Pompei P, Ales KL, MacKenzie CR: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–383.
  22. Scarmeas N, Brandt J, Albert M, et al: Delusions and hallucinations are associated with worse outcome in Alzheimer disease. Arch Neurol 2005;62:1601–1608.
  23. Rabe-Hesketh S, Skrondal A: Multilevel and Longitudinal Modeling Using Stata. College Station, Stata Press, 2005.
  24. Kennedy P: Estimation with correctly interpreted dummy variables in semilogarithmic equations. Am Econ Rev 1981;71:801.

    External Resources

  25. Stata Statistical Software: Release 9. College Station, StataCorp, 2005.
  26. Gold M, Siegel J, Russell L, Weinstein M: Cost-Effectiveness in Health and Medicine. Oxford, Oxford University Press, 1996.
  27. Economic Report of the President. Transmitted to the Congress, February 2006. Washington, United States Government Printing Office, 2006.
  28. Murman DL, Chen Q, Powell MC, Kuo SB, Bradley CJ, Colenda CC: The incremental direct costs associated with behavioral symptoms in AD. Neurology 2002;59:1721–1729.
  29. Corder LS, Woodbury MA, Manton KG: Proxy response patterns among the aged: effects on estimates of health status and medical care utilization from the 1982–1984 long-term care surveys. J Clin Epidemiol 1996;49:173–182.
  30. Neumann PJ, Araki SS, Gutterman EM: The use of proxy respondents in studies of older adults: lessons, challenges, and opportunities. J Am Geriatr Soc 2000;48:1646–1654.
  31. Bloom BS, de Pouvourville N, Straus WL: Cost of illness of Alzheimer’s disease: how useful are current estimates? Gerontologist 2003;43:158–164.

  

Author Contacts

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 carolyn.zhu@mssm.edu

  

Article Information

Accepted: August 5, 2008
Published online: October 22, 2008
Number of Print Pages : 8
Number of Figures : 2, Number of Tables : 4, Number of References : 34

  

Publication Details

Dementia and Geriatric Cognitive Disorders

Vol. 26, No. 5, Year 2008 (Cover Date: November 2008)

Journal Editor: Chan-Palay V. (New York, N.Y.)
ISSN: 1420–8008 (Print), eISSN: 1421–9824 (Online)

For additional information: http://www.karger.com/DEM


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Abstract

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.

© 2008 S. Karger AG, Basel


  

Author Contacts

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 carolyn.zhu@mssm.edu

  

Article Information

Accepted: August 5, 2008
Published online: October 22, 2008
Number of Print Pages : 8
Number of Figures : 2, Number of Tables : 4, Number of References : 34

  

Publication Details

Dementia and Geriatric Cognitive Disorders

Vol. 26, No. 5, Year 2008 (Cover Date: November 2008)

Journal Editor: Chan-Palay V. (New York, N.Y.)
ISSN: 1420–8008 (Print), eISSN: 1421–9824 (Online)

For additional information: http://www.karger.com/DEM


Article / Publication Details

First-Page Preview
Abstract of Original Research Article

Accepted: 8/5/2008
Published online: 10/22/2008
Issue release date: November 2008

Number of Print Pages: 8
Number of Figures: 2
Number of Tables: 4

ISSN: 1420-8008 (Print)
eISSN: 1421-9824 (Online)

For additional information: http://www.karger.com/DEM


Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Centers for Disease Control, National Center for Chronic Disease Prevention and Health Promotion: Unrealized Prevention Opportunities: Reducing the Health and Economic Burden of Chronic Illness. November 2000.
  2. Taylor DH Jr, Schenkman M, Zhou J, Sloan FA: The relative effect of Alzheimer’s disease and related dementias, disability, and comorbidities on cost of care for elderly persons. J Gerontol B Psychol Sci Soc Sci 2001;56:S285–S293.
  3. Small GW, McDonnell DD, Brooks RL, Papadopoulos G: The impact of symptom severity on the cost of Alzheimer’s disease. J Am Geriatr Soc 2002;50:321–327.
  4. Zhu CW, Scarmeas N, Torgan R, et al: Clinical characteristics and longitudinal changes of informal cost of Alzheimer’s disease in the community. J Am Geriatr Soc 2006;54:1596–1602.
  5. Zhu CW, Scarmeas N, Torgan R, et al: Longitudinal study of effects of patient characteristics on direct costs in Alzheimer disease. Neurology 2006;67:998–1005.
  6. Blessed G, Tomlinson BE, Roth M: The association between quantitative measures of dementia and of senile change in the cerebral grey matter of elderly subjects. Br J Psychiatry 1968;114:797–811.
  7. Stern Y, Albert SM, Sano M, et al: Assessing patient dependence in Alzheimer’s disease. J Gerontol 1994;49:M216–M222.
  8. Brickman AM, Riba A, Bell K, et al: Longitudinal assessment of patient dependence in Alzheimer disease. Arch Neurol 2002;59:1304–1308.
  9. Holtzer R, Tang MX, Devanand DP, et al: Psychopathological features in Alzheimer’s disease: course and relationship with cognitive status. J Am Geriatr Soc 2003;51:953–960.
  10. Sarazin M, Stern Y, Berr C, et al: Neuropsychological predictors of dependency in patients with Alzheimer disease. Neurology 2005;64:1027–1031.
  11. Murman DL, Von Eye A, Sherwood PR, Liang J, Colenda CC: Evaluated need, costs of care, and payer perspective in degenerative dementia patients cared for in the United States. Alzheimer Dis Assoc Disord 2007;21:39–48.
  12. Zhu CW, Leibman C, McLaughlin T, et al: The effects of patient function and dependence on costs of care in Alzheimer’s disease. J Am Geriatr Soc, in press.
  13. Stern Y, Folstein M, Albert M, et al: Multicenter study of predictors of disease course in Alzheimer disease (the ‘predictors study’). 1. Study design, cohort description, and intersite comparisons. Alzheimer Dis Assoc Disord 1993;7:3–21.
  14. Richards M, Folstein M, Albert M, et al: Multicenter study of predictors of disease course in Alzheimer disease (the ‘predictors study’). II. Neurological, psychiatric, and demographic influences on baseline measures of disease severity. Alzheimer Dis Assoc Disord 1993;7:22–32.
  15. Folstein MF, Folstein SE, McHugh PR: ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–198.
  16. Stern Y, Sano M, Paulson J, Mayeux R: Modified Mini-Mental State Examination: validity and reliability. Neurology 1987;37:179.

    External Resources

  17. Mirra SS: The CERAD neuropathology protocol and consensus recommendations for the postmortem diagnosis of Alzheimer’s disease: a commentary. Neurobiol Aging 1997;18:S91–S94.
  18. The National Institute on Aging, and Reagan Institute Working Group on Diagnostic Criteria for the Neuropathological Assessment of Alzheimer’s Disease: Consensus recommendations for the postmortem diagnosis of Alzheimer’s disease. Neurobiol Aging 1997;18:S1–S2.
  19. Leon J, Cheng CK, Neumann PJ: Alzheimer’s disease care: costs and potential savings. Health Aff (Millwood) 1998;17:206–216.
  20. Menzin J, Lang K, Friedman M, Neumann P, Cummings JL: The economic cost of Alzheimer’s disease and related dementias to the California Medicaid program (‘Medi-Cal’) in 1995. Am J Geriatr Psychiatry 1999;7:300–308.
  21. Charlson ME, Pompei P, Ales KL, MacKenzie CR: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–383.
  22. Scarmeas N, Brandt J, Albert M, et al: Delusions and hallucinations are associated with worse outcome in Alzheimer disease. Arch Neurol 2005;62:1601–1608.
  23. Rabe-Hesketh S, Skrondal A: Multilevel and Longitudinal Modeling Using Stata. College Station, Stata Press, 2005.
  24. Kennedy P: Estimation with correctly interpreted dummy variables in semilogarithmic equations. Am Econ Rev 1981;71:801.

    External Resources

  25. Stata Statistical Software: Release 9. College Station, StataCorp, 2005.
  26. Gold M, Siegel J, Russell L, Weinstein M: Cost-Effectiveness in Health and Medicine. Oxford, Oxford University Press, 1996.
  27. Economic Report of the President. Transmitted to the Congress, February 2006. Washington, United States Government Printing Office, 2006.
  28. Murman DL, Chen Q, Powell MC, Kuo SB, Bradley CJ, Colenda CC: The incremental direct costs associated with behavioral symptoms in AD. Neurology 2002;59:1721–1729.
  29. Corder LS, Woodbury MA, Manton KG: Proxy response patterns among the aged: effects on estimates of health status and medical care utilization from the 1982–1984 long-term care surveys. J Clin Epidemiol 1996;49:173–182.
  30. Neumann PJ, Araki SS, Gutterman EM: The use of proxy respondents in studies of older adults: lessons, challenges, and opportunities. J Am Geriatr Soc 2000;48:1646–1654.
  31. Bloom BS, de Pouvourville N, Straus WL: Cost of illness of Alzheimer’s disease: how useful are current estimates? Gerontologist 2003;43:158–164.