The Effects of Patient Function and Dependence on Costs of Care in Alzheimer's Disease

Authors

  • Carolyn W. Zhu PhD,

    1. From the *Geriatric Research, Education, and Clinical Center and Program of Research on Serious Physical and Mental Illness, Targeted Research Enhancement Program, James J. Peters Veterans Affairs Medical Center, Bronx, New YorkBrookdale Department of Geriatrics††Department of Psychiatry, Mount Sinai School of Medicine, New York, New YorkElan Pharmaceuticals Inc., South San Francisco, California§Cognitive Neuroscience Division, Taub Institute for Research in Alzheimer's Disease and the Aging Brain, New York, New YorkGertrude H. Sergievsky Center and Department of Neurology, Columbia University Medical Center, New York, New York#Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland**Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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  • Christopher Leibman PharmD, MS,

    1. From the *Geriatric Research, Education, and Clinical Center and Program of Research on Serious Physical and Mental Illness, Targeted Research Enhancement Program, James J. Peters Veterans Affairs Medical Center, Bronx, New YorkBrookdale Department of Geriatrics††Department of Psychiatry, Mount Sinai School of Medicine, New York, New YorkElan Pharmaceuticals Inc., South San Francisco, California§Cognitive Neuroscience Division, Taub Institute for Research in Alzheimer's Disease and the Aging Brain, New York, New YorkGertrude H. Sergievsky Center and Department of Neurology, Columbia University Medical Center, New York, New York#Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland**Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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  • Trent McLaughlin PhD,

    1. From the *Geriatric Research, Education, and Clinical Center and Program of Research on Serious Physical and Mental Illness, Targeted Research Enhancement Program, James J. Peters Veterans Affairs Medical Center, Bronx, New YorkBrookdale Department of Geriatrics††Department of Psychiatry, Mount Sinai School of Medicine, New York, New YorkElan Pharmaceuticals Inc., South San Francisco, California§Cognitive Neuroscience Division, Taub Institute for Research in Alzheimer's Disease and the Aging Brain, New York, New YorkGertrude H. Sergievsky Center and Department of Neurology, Columbia University Medical Center, New York, New York#Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland**Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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  • Nikolaos Scarmeas MD, MSc,

    1. From the *Geriatric Research, Education, and Clinical Center and Program of Research on Serious Physical and Mental Illness, Targeted Research Enhancement Program, James J. Peters Veterans Affairs Medical Center, Bronx, New YorkBrookdale Department of Geriatrics††Department of Psychiatry, Mount Sinai School of Medicine, New York, New YorkElan Pharmaceuticals Inc., South San Francisco, California§Cognitive Neuroscience Division, Taub Institute for Research in Alzheimer's Disease and the Aging Brain, New York, New YorkGertrude H. Sergievsky Center and Department of Neurology, Columbia University Medical Center, New York, New York#Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland**Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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  • Marilyn Albert PhD,

    1. From the *Geriatric Research, Education, and Clinical Center and Program of Research on Serious Physical and Mental Illness, Targeted Research Enhancement Program, James J. Peters Veterans Affairs Medical Center, Bronx, New YorkBrookdale Department of Geriatrics††Department of Psychiatry, Mount Sinai School of Medicine, New York, New YorkElan Pharmaceuticals Inc., South San Francisco, California§Cognitive Neuroscience Division, Taub Institute for Research in Alzheimer's Disease and the Aging Brain, New York, New YorkGertrude H. Sergievsky Center and Department of Neurology, Columbia University Medical Center, New York, New York#Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland**Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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  • Jason Brandt PhD,

    1. From the *Geriatric Research, Education, and Clinical Center and Program of Research on Serious Physical and Mental Illness, Targeted Research Enhancement Program, James J. Peters Veterans Affairs Medical Center, Bronx, New YorkBrookdale Department of Geriatrics††Department of Psychiatry, Mount Sinai School of Medicine, New York, New YorkElan Pharmaceuticals Inc., South San Francisco, California§Cognitive Neuroscience Division, Taub Institute for Research in Alzheimer's Disease and the Aging Brain, New York, New YorkGertrude H. Sergievsky Center and Department of Neurology, Columbia University Medical Center, New York, New York#Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland**Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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  • Deborah Blacker MD, ScD,

    1. From the *Geriatric Research, Education, and Clinical Center and Program of Research on Serious Physical and Mental Illness, Targeted Research Enhancement Program, James J. Peters Veterans Affairs Medical Center, Bronx, New YorkBrookdale Department of Geriatrics††Department of Psychiatry, Mount Sinai School of Medicine, New York, New YorkElan Pharmaceuticals Inc., South San Francisco, California§Cognitive Neuroscience Division, Taub Institute for Research in Alzheimer's Disease and the Aging Brain, New York, New YorkGertrude H. Sergievsky Center and Department of Neurology, Columbia University Medical Center, New York, New York#Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland**Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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  • Mary Sano PhD,

    1. From the *Geriatric Research, Education, and Clinical Center and Program of Research on Serious Physical and Mental Illness, Targeted Research Enhancement Program, James J. Peters Veterans Affairs Medical Center, Bronx, New YorkBrookdale Department of Geriatrics††Department of Psychiatry, Mount Sinai School of Medicine, New York, New YorkElan Pharmaceuticals Inc., South San Francisco, California§Cognitive Neuroscience Division, Taub Institute for Research in Alzheimer's Disease and the Aging Brain, New York, New YorkGertrude H. Sergievsky Center and Department of Neurology, Columbia University Medical Center, New York, New York#Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland**Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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  • Yaakov Stern PhD

    1. From the *Geriatric Research, Education, and Clinical Center and Program of Research on Serious Physical and Mental Illness, Targeted Research Enhancement Program, James J. Peters Veterans Affairs Medical Center, Bronx, New YorkBrookdale Department of Geriatrics††Department of Psychiatry, Mount Sinai School of Medicine, New York, New YorkElan Pharmaceuticals Inc., South San Francisco, California§Cognitive Neuroscience Division, Taub Institute for Research in Alzheimer's Disease and the Aging Brain, New York, New YorkGertrude H. Sergievsky Center and Department of Neurology, Columbia University Medical Center, New York, New York#Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland**Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Address correspondence to Carolyn W. Zhu, Geriatric Research, Education, and Clinical Center (GRECC), James J. Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468. E-mail: carolyn.zhu@mssm.edu

Abstract

OBJECTIVES: To estimate incremental effects of patients' dependence and function on costs of care during the early stages of Alzheimer's disease (AD) and to compare strengths of their relationships with different cost components.

DESIGN: Multicenter, cross-sectional, observational study.

SETTING: Three university hospitals in the United States.

PARTICIPANTS: One hundred seventy-nine community-living patients with probable AD, with modified Mini-Mental State Examination scores of 30 or higher.

MEASUREMENTS: Patients' dependence was measured using the Dependence Scale (DS). Functional capacity was measured using the Blessed Dementia Rating Scale (BDRS). Total cost was measured by summing direct medical costs and informal costs. Direct medical costs included costs of hospitalization, outpatient treatment and procedures, assistive devices, and medications. Informal costs were estimated from time spent helping with basic and instrumental activities of daily living for up to three caregivers per patient using national average hourly earnings as wage rate.

RESULTS: DS and BDRS were associated with higher total cost; a 1-point increase in DS was associated with a $1,832 increase in total cost, and a 1-point increase in BDRS was associated with a $3,333 increase. Examining component costs separately identified potential differences between DS and BDRS. A 1-point increase in BDRS was associated with a $1,406 increase in direct medical cost. A 1-point increase in DS was associated with a $1,690 increase in informal cost.

CONCLUSION: Patients' dependence and function related differently to direct medical and informal cost, suggesting that measures of function and dependence provided unique information for explaining variations in cost of care for patients with AD, highlighting the value in measuring both constructs.

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