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Clinical features associated with costs in early AD

Baseline data from the Predictors Study

From the Geriatric Research, Education, and Clinical Center and Program of Research on Serious Physical and Mental Illness (C.W.Z., M.S.), Targeted Research Enhancement Program, Bronx VA Medical Center, Brookdale Department of Geriatrics (C.W.Z.), and Department of Psychiatry (M.S.), Mount Sinai School of Medicine, New York, NY; Cognitive Neuroscience Division of the Taub Institute for Research in Alzheimer's Disease and the Aging Brain (N.S., R.T., Y.S.) and Gertrude H. Sergievsky Center and Department of Neurology (N.S., R.T., Y.S.), Columbia University College of Physicians and Surgeons, New York, NY; Department of Psychiatry and Behavioral Sciences (M.A., J.B.), Johns Hopkins University, Baltimore, MD; and Department of Psychiatry (D.B.), Massachusetts General Hospital, Harvard Medical School, Boston, MA.

Address correspondence and reprint requests to Dr. C. Zhu, Geriatric Research, Education, and Clinical Center (GRECC), Bronx VA Medical Center, 130 Kingsbridge Rd., Bronx NY, 10468; e-mail: carolyn.zhu{at}mssm.edu

Background: Few studies on cost of caring for patients with Alzheimer disease (AD) have simultaneously considered multiple dimensions of disease costs and detailed clinical characteristics.

Objective: To estimate empirically the incremental effects of patients' clinical characteristics on disease costs.

Methods: Data are derived from the baseline visit of 180 patients in the Predictors Study, a large, multicenter cohort of patients with probable AD followed from early stages of the disease. All patients initially lived at home, in retirement homes, or in assisted living facilities. Costs of direct medical care included hospitalizations, outpatient treatment and procedures, assistive devices, and medications. Costs of direct nonmedical care included home health aides, respite care, and adult day care. Indirect costs were measured by caregiving time. Patients' clinical characteristics included cognitive status, functional capacity, psychotic symptoms, behavioral problems, depressive symptoms, extrapyramidal signs, comorbidities, and duration of illness.

Results: A 1-point increase in the Blessed Dementia Rating Scale score was associated with a $1,411 increase in direct medical costs and a $2,718 increase in unpaid caregiving costs. Direct medical costs also were $3,777 higher among subjects with depressive symptoms than among those who were not depressed.

Conclusions: Medical care costs and unpaid caregiving costs relate differently to patients' clinical characteristics. Poorer functional status is associated with higher medical care costs and unpaid caregiving costs. Interventions may be particularly useful if targeted in the areas of basic and instrumental activities of daily living.

The Predictors Study is supported by federal grants AG07370, RR00645, and U01AG010483. Drs. Zhu and Sano also are supported by the Department of Veterans Affairs, Veterans Health Administration.

Disclosure: The authors report no conflicts of interest.

The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

Received June 30, 2005. Accepted in final form December 19, 2005.

This article has been cited by other articles:

				C. W. Zhu, N. Scarmeas, R. Torgan, M. Albert, J. Brandt, D. Blacker, M. Sano, and Y. Stern Longitudinal study of effects of patient characteristics on direct costs in Alzheimer disease Neurology, September 26, 2006; 67(6): 998 - 1005. [Abstract] [Full Text] [PDF]