Abstract
Objective
To compare the associations between dependence and clinical measures of cognition, function and behaviour and total care cost using data from a longitudinal study in Alzheimer’s disease (AD).
Design
Longitudinal, observational study.
Setting
Community-dwelling subjects.
Participants
Male and female subjects between 50 and 85 years of age with mild to moderate AD.
Intervention
None.
Measurements
Subject dependence was assessed using the Dependence Scale (DS), cognition (ADAS-Cog, MMSE), function (DAD), behaviour (NPI) and resource utilization with the Resource Utilization in Dementia Questionnaire.
Results
The repeated measures models confirmed a significant association between the DS and total care cost indicating an increase in cost with increasing dependence. A 1-unit increase in DS score was associated with a 28.60% increase in total care cost. Model 2 indicated that a one point change in MMSE, DAD and NPI is associated with 5.29%, 2.32% and 1.71% increase in total cost, respectively. Model 3 indicated that a one point change in ADAS-Cog, DAD and NPI is associated with a 1.74%, 2.42%and 1.62% increase in total cost, respectively.
Conclusion
Strategies which prevent deterioration in clinical measures or delay dependence should result in total cost savings. The quantitative relationships observed should assist in the economic assessment of interventions which effect cognition, function, behaviour and dependence.
Similar content being viewed by others
References
Alzheimer’s Association. 2012 Alzheimer’s Disease Facts and Figures. http://www.alz.org/downloads/facts_figures_2012.pdf. Published 2012. Accessed 8 May 2012
McLaughlin T, Feldman H, Fillit H, Sano M, Schmitt F, Aisen P, Leibman C, Mucha L, Ryan JM, Sullivan SD, Spackman DE, Neumann PJ, Cohen J, Stern Y. Dependence as a unifying construct in defining Alzheimer’s disease severity. Alzheimers Dement 2010;6:482–493
McLaughlin T, Buxton M, Mittendorf T, Redekop W, Mucha L, Darba J, Jonsson L, Lacey L, Leibman C. Assessment of potential measures in models of progression in Alzheimer disease. Neurology 2010;75:1256–1262
Zhu CW, Leibman C, McLaughlin T, Scarmeas N, Albert M, Brandt J, Blacker D, Sano M, Stern Y. The effects of patient function and dependence on costs of care in Alzheimer’s disease. J Am Geriatr Soc 2008;56:1497–1503
Zhu CW, Leibman C, McLaughlin T, Zbrozek, Scarmeas N, Albert M, Brandt, J, Blacker D, Sano M, Stern Y. Patient dependence and longitudinal changes in costs of care in Alzheimers disease. Dementia Geriatri Cogn Disord 2008;26:416–423
Murman DL, Von EA, 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
Mauskopf J, Racketa J, Sherrill E. Alzheimer disease: the strength of association of costs with different measures of disease severity. JNHA 2010;14(8):655–663.
Jonsson L, Eriksdotter Jonhagen M, Kilander L, Soininen H, Hallikainen M, Waldemar G, Nygaard, H, Andreasen N, Winblad B, Wimo A. Determinants of costs of care for patients with Alzheimer’s disease. Int J Geriatr Psychiatry 2006; 21: 449–459
Zhu CW, Scarmeas N, Torgan R, Albert M, Brandt J, Blacker D, Sano M, Stern Y. Longitudinal study of effects of patient characteristics on direct costs in Alzheimer disease. Neurology 2006; 67: 998–1005
Gustavsson A, Cattelin F, Jonsson L. Costs of care in a mild-moderate Alzheimer clinical trial sample: Key resources and their determinants. Alzheimer’s and Dementia 2011; 7: 466–473
Rapp T, Andrieu S, Molinier L, Grand A, Cantet C, Mullins D, Vellas B. Exploring the relationship between Alzheimer’s disease severity and longitudinal costs. Value in Health 2012;15(3): 412–419
Alzheimer’s Disease Neuroimaging Initiative. Alzheimer’s Disease Neuroimaging Protocol (ADNI). http://www.adni-info.org/Pdfs/adni_protocol_9_19_08.pdf. Published 2005. Accessed 8 May 8 2012
Rosen WG, Terry RD, Fuld PA, Katzman R, Peck A. Pathological verification of ischemic score in differentiation of dementias. Ann Neurol 1980;7:486–488
Stern Y, Albert SM, Sano M, Richards M, Miller L, Folstein M, Albert M, Bylsma FW, Lafleche G. Assessing patient dependence in Alzheimer’s disease. J Gerontol 1994;49:M216–M222
Brickman AM, Riba A, Bell K, Marder K, Albert M, Brandt J, Stern Y. Longitudinal assessment of patient dependence in Alzheimer disease. Arch Neurol 2002;59:1304–1308
Folstein M, Folstein S, McHugh P. Mini-Mental State: A practical method for grading the cognitive state of patients for the clinician. J Psychiat res 1975; 12: 189–198.
Rosen WG, Mohs RC, Davis KL. A new rating scale for Alzheimer’s disease. Am J Psychiatry 1984;141:1356–64.
Gélinas I, Gauthier L, McIntyre M, Gauthier S. Development of a functional measure for persons with Alzheimer’s disease: the disability assessment for dementia. Am J Occup Ther. 1999; 53(5):471–481.
Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J. (1994) The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology 44(12):2308–2314.
Wimo A, Nordberg G. Validity and reliability of assessments of time. Comparisons of direct observations and estimates of time by the use of the resource utilization in dementia (RUD)-instrument. Arch Gerontol Geriatr 2007;44:71–81
Market Survey of Long -term Care costs. The 2010 MetLife market Survey of Nursing Home, Assisted Living, adult Day services and Home Care costs. Metlife Mature Market Institute.
Beebe M, Dalton JA, Espronceda M, Evans D, Glenn R. CPT 2008 Professional Ed Published by the American Medical Association. CPT code 99349, page 83 of 2008 PF&CG.
Wier LM, Levit K, Stranges E et al. U S Agency for Healthcare Research and Quality. HCUP Facts and Figures: Statistics on Hospital-based Care in the United States, 2008. http://www.hcup-us.ahrq.gov/reports/factsandfigures/2008/highlights.jsp. Published 2008. Accessed 9 July 2012
Beebe M, Dalton JA, Espronceda M, Evans D, Glenn R. CPT 2008 Professional Ed Published by the American Medical Association. CPT code 99243, page 69 of 2008 PF&CG
National Compensation survey for 2007–2009. Accessed at http://www.bls.gov/eci/
SAS Institute Inc. SAS/STAT 9.2 User’s Guide. http://support.sas.com/documentation/cdl/en/statugmixed/61807/PDF/default/statugmixed.pdf. Published 2008. Accessed 9 May 2012
Author information
Authors and Affiliations
Consortia
Corresponding author
Rights and permissions
About this article
Cite this article
Lacey, L.A., Niecko, T., Leibman, C. et al. Association between illness progression measures and total cost in Alzheimer’s disease. J Nutr Health Aging 17, 745–750 (2013). https://doi.org/10.1007/s12603-013-0368-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12603-013-0368-1