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Tay LX, Ong SC, Tay LJ, Ng T, Parumasivam T. Economic Burden of Alzheimer's Disease: A Systematic Review. Value Health Reg Issues 2024; 40:1-12. [PMID: 37972428 DOI: 10.1016/j.vhri.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/18/2023] [Accepted: 09/28/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES Alzheimer's disease (AD) has become one of the most prevalent neurodegenerative disorders among the elderly. The global cost of dementia is expected to reach US $2 trillion in 2030. In this systematic review, existing evidence on the cost of dementia specific to AD is appraised. METHODS A comprehensive search was done on 3 databases, namely PubMed, ScienceDirect, and Web of Science, to identify original cost-of-illness studies that only evaluate the economic burden of AD up to August 2022. The risk of bias in the studies was assessed using Consolidated Health Economic Evaluation Reporting Standards 2022 criteria. Cost articles without specifying etiology of AD or those in non-English were excluded. RESULTS Twelve of 5536 studies met the inclusion criteria. The total annual cost of AD per capita ranged from US $468.28 in mild AD to US $171 283.80 in severe AD. The cost of care raised nonlinearly with disease severity. Indirect caregiving cost represented the main contributor to societal cost in community-dwelling patients. When special caregiving accommodation was opted in daily care, it results in cost shifting from indirect cost to direct nonmedical cost. Formal caregiving accommodation caused increase in direct cost up to 67.3% of overall economic burden of the disease. CONCLUSIONS AD exerts a huge economic burden on patients and caregivers. Overall rise of each cost component could be anticipated with disease deterioration. Choice of special caregiving accommodation could reduce caregiver's productivity loss but increase the direct nonmedical expenditure of the disease from societal perspective.
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Affiliation(s)
- Lyn Xuan Tay
- Discipline of Social and Administrative Pharmacy, Universiti Sains Malaysia, Pulau Pinang, Gelugor, Malaysia
| | - Siew Chin Ong
- Discipline of Social and Administrative Pharmacy, Universiti Sains Malaysia, Pulau Pinang, Gelugor, Malaysia.
| | - Lynn Jia Tay
- School of International Education, An Hui Medical University, He Fei, An Hui, China
| | - Trecia Ng
- West China School of Medicine, Si Chuan University, Cheng Du, Si Chuan, China
| | - Thaigarajan Parumasivam
- Discipline of Pharmaceutical Technology, Universiti Sains Malaysia, Pulau Pinang, Gelugor, Malaysia
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2
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Lopera F, Custodio N, Rico-Restrepo M, Allegri RF, Barrientos JD, Garcia Batres E, Calandri IL, Calero Moscoso C, Caramelli P, Duran Quiroz JC, Jansen AM, Mimenza Alvarado AJ, Nitrini R, Parodi JF, Ramos C, Slachevsky A, Brucki SMD. A task force for diagnosis and treatment of people with Alzheimer's disease in Latin America. Front Neurol 2023; 14:1198869. [PMID: 37497015 PMCID: PMC10367107 DOI: 10.3389/fneur.2023.1198869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 06/21/2023] [Indexed: 07/28/2023] Open
Abstract
Alzheimer's disease (AD) represents a substantial burden to patients, their caregivers, health systems, and society in Latin America and the Caribbean (LAC). This impact is exacerbated by limited access to diagnosis, specialized care, and therapies for AD within and among nations. The region has varied geographic, ethnic, cultural, and economic conditions, which create unique challenges to AD diagnosis and management. To address these issues, the Americas Health Foundation convened a panel of eight neurologists, geriatricians, and psychiatrists from Argentina, Brazil, Colombia, Ecuador, Guatemala, Mexico, and Peru who are experts in AD for a three-day virtual meeting to discuss best practices for AD diagnosis and treatment in LAC and create a manuscript offering recommendations to address identified barriers. In LAC, several barriers hamper diagnosing and treating people with dementia. These barriers include access to healthcare, fragmented healthcare systems, limited research funding, unstandardized diagnosis and treatment, genetic heterogeneity, and varying social determinants of health. Additional training for physicians and other healthcare workers at the primary care level, region-specific or adequately adapted cognitive tests, increased public healthcare insurance coverage of testing and treatment, and dedicated search strategies to detect populations with gene variants associated with AD are among the recommendations to improve the landscape of AD.
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Affiliation(s)
- Francisco Lopera
- Grupo de Neurociencias de Antioquia, Universidad de Antioquia, Medellín, Colombia
| | - Nilton Custodio
- Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista, Lima, Peru
| | | | - Ricardo F. Allegri
- Department of Cognitive Neurology, Instituto Neurológico Fleni, Buenos Aires, Argentina
| | | | - Estuardo Garcia Batres
- Geriatric Unit, New Hope, Interior Hospital Atención Medica Siloé, Ciudad de Guatemala, Guatemala
| | - Ismael L. Calandri
- Department of Cognitive Neurology, Instituto Neurológico Fleni, Buenos Aires, Argentina
| | - Cristian Calero Moscoso
- Department of Neurology, HCAM Memory and Behavior Unit, University of Hospital Carlos Andrade Marin HCAM, Quito, Ecuador
| | - Paulo Caramelli
- Behavioral and Cognitive Neurology Research Group, Faculty of Medicine, University of Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Juan Carlos Duran Quiroz
- Faculty of Medicine, Department of Functional Sciences, Physiology Division, Universidad Mayor de San Andres, La Paz, Bolivia
| | | | - Alberto José Mimenza Alvarado
- Memory Disorders Clinic, Neurological Geriatrics Program, Department of Geriatrics, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Ricardo Nitrini
- Cognitive and Behavioral Neurology Group, Department of Neurology, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Jose F. Parodi
- Centro de Investigación del Envejecimiento, Facultad de Medicina, Universidad de San Martín de Porres, Lima, Peru
| | - Claudia Ramos
- Antioquia Neurosciences Group, University of Antioquia, Medellin, Colombia
| | - Andrea Slachevsky
- Geroscience Center for Brain Health and Metabolism (GERO), University of Chile, Santiago, Chile
| | - Sonia María Dozzi Brucki
- Cognitive and Behavioral Neurology Group, Department of Neurology, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
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3
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Kenne Malaha A, Thébaut C, Achille D, Preux PM, Guerchet M. Costs of Dementia in Low- And Middle-Income Countries: A Systematic Review. J Alzheimers Dis 2023; 91:115-128. [PMID: 36404540 DOI: 10.3233/jad-220239] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The proportion of people living with dementia in low- and middle-income countries (LMICs) is expected to reach 71% by 2050. Appraising the economic burden of the disease may contribute to strategic policy planning. OBJECTIVE To review studies conducted on the costs of dementia in LMICs, describe their methodology and summarize available costs estimates. METHODS Systematic review, including a search of health, economics, and social science bibliographic databases. No date or language restrictions were applied. All studies with a direct measure of the costs of dementia care were included. RESULTS Of the 6,843 publications reviewed, 17 studies from 11 LMICs were included. Costs of dementia tended to increase with the severity of the disease. Medical costs were greater in the mild stage, while social and informal care costs were highest in the moderate and severe stages. Annual cost estimates per patient ranged from PPP$131.0 to PPP$31,188.8 for medical costs; from PPP$16.1 to PPP$10,581.7 for social care services and from PPP$140.0 to PPP$25,798 for informal care. Overall, dementia care can cost from PPP$479.0 to PPP$66,143.6 per year for a single patient. CONCLUSION Few studies have been conducted on the costs of dementia in LMICs, and none so far in Africa. There seems to be a need to provide accurate data on the burden of disease in these countries to guide public health policies in the coming decades.
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Affiliation(s)
- Angeladine Kenne Malaha
- Inserm U1094, IRD UMR270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, Omega Health, Limoges, France
| | - Clémence Thébaut
- Inserm U1094, IRD UMR270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, Omega Health, Limoges, France.,Leda-Legos, PSL Research University, Paris Dauphine University, Paris, France
| | - Dayna Achille
- Inserm U1094, IRD UMR270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, Omega Health, Limoges, France
| | - Pierre-Marie Preux
- Inserm U1094, IRD UMR270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, Omega Health, Limoges, France.,CHU, Centre d'Epidémiologie de Biostatistiqueet de Méthodologie de la Recherche, Limoges, France
| | - Maëlenn Guerchet
- Inserm U1094, IRD UMR270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, Omega Health, Limoges, France
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4
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Mattap SM, Mohan D, McGrattan AM, Allotey P, Stephan BC, Reidpath DD, Siervo M, Robinson L, Chaiyakunapruk N. The economic burden of dementia in low- and middle-income countries (LMICs): a systematic review. BMJ Glob Health 2022; 7:bmjgh-2021-007409. [PMID: 35379735 PMCID: PMC8981345 DOI: 10.1136/bmjgh-2021-007409] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 02/08/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction More than two-thirds of people with dementia live in low- and middle-income countries (LMICs), resulting in a significant economic burden in these settings. In this systematic review, we consolidate the existing evidence on the cost of dementia in LMICs. Methods Six databases were searched for original research reporting on the costs associated with all-cause dementia or its subtypes in LMICs. The national-level dementia costs inflated to 2019 were expressed as percentages of each country’s gross domestic product (GDP) and summarised as the total mean percentage of GDP. The risk of bias of studies was assessed using the Larg and Moss method. Results We identified 14 095 articles, of which 24 studies met the eligibility criteria. Most studies had a low risk of bias. Of the 138 LMICs, data were available from 122 countries. The total annual absolute per capita cost ranged from US$590.78 for mild dementia to US$25 510.66 for severe dementia. Costs increased with the severity of dementia and the number of comorbidities. The estimated annual total national costs of dementia ranged from US$1.04 million in Vanuatu to US$195 billion in China. The average total national expenditure on dementia estimated as a proportion of GDP in LMICs was 0.45%. Indirect costs, on average, accounted for 58% of the total cost of dementia, while direct costs contributed 42%. Lack of nationally representative samples, variation in cost components, and quantification of indirect cost were the major methodological challenges identified in the existing studies. Conclusion The estimated costs of dementia in LMICs are lower than in high-income countries. Indirect costs contribute the most to the LMIC cost. Early detection of dementia and management of comorbidities is essential for reducing costs. The current costs are likely to be an underestimation due to limited dementia costing studies conducted in LMICs, especially in countries defined as low- income. PROSPERO registration number The protocol was registered in the International Prospective Register of Systematic Reviews database with registration number CRD42020191321.
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Affiliation(s)
- Siti Maisarah Mattap
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Devi Mohan
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Andrea Mary McGrattan
- School of Biomedical, Nutritional and Sports Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Pascale Allotey
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia.,United Nations University International Institute for Global Health, Bandar Tun Razak, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | | | - Daniel D Reidpath
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh.,Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Mario Siervo
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Louise Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, The University of Utah College of Pharmacy, Salt Lake City, Utah, USA.,School of Pharmacy, Monash University Malaysia, Selangor, Malaysia.,IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah, USA
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5
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Ibáñez A, Pina-Escudero SD, Possin KL, Quiroz YT, Peres FA, Slachevsky A, Sosa AL, Brucki SMD, Miller BL; Multi-Partner Consortium to Expand Dementia Research in Latin America. Dementia caregiving across Latin America and the Caribbean and brain health diplomacy. Lancet Healthy Longev 2021; 2:e222-31. [PMID: 34790905 DOI: 10.1016/s2666-7568(21)00031-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The prevalence of dementia in Latin America and the Caribbean is growing rapidly, increasing the burden placed on caregivers. Exacerbated by fragile health-care systems, unstable economies, and extensive inequalities, caregiver burden in this region is among the highest in the world. We reviewed the major challenges to caregiving in Latin America and the Caribbean, and we propose regional and coordinated actions to drive future change. Current challenges include the scarcity of formal long-term care, socioeconomic and social determinants of health disparities, gender-biased burdens, growing dementia prevalence, and the effect of the current COVID-19 pandemic on families affected by dementia. Firstly, we propose local and regional short-term strategic recommendations, including systematic identification of specific caregiver needs, testing of evidence-based local interventions, contextual adaptation of strategies to different settings and cultures, countering gender bias, strengthening community support, provision of basic technology, and better use of available information and communications technology. Additionally, we propose brain health diplomacy (ie, global actions aimed to overcome the systemic challenges to brain health by bridging disciplines and sectors) and convergence science as frameworks for long-term coordinated responses, integrating tools, knowledge, and strategies to expand access to digital technology and develop collaborative models of care. Addressing the vast inequalities in dementia caregiving across Latin America and the Caribbean requires innovative, evidence-based solutions coordinated with the strengthening of public policies.
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6
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Morris K, Nami M, Bolanos JF, Lobo MA, Sadri-Naini M, Fiallos J, Sanchez GE, Bustos T, Chintam N, Amaya M, Strand SE, Mayuku-Dore A, Sakibova I, Biso GMN, DeFilippis A, Bravo D, Tarhan N, Claussen C, Mercado A, Braun S, Yuge L, Okabe S, Taghizadeh-Hesary F, Kotliar K, Sadowsky C, Chandra PS, Tripathi M, Katsaros V, Mehling B, Noroozian M, Abbasioun K, Amirjamshidi A, Hossein-Zadeh GA, Naraghi F, Barzegar M, Asadi-Pooya AA, Sahab-Negah S, Sadeghian S, Fahnestock M, Dilbaz N, Hussain N, Mari Z, Thatcher RW, Sipple D, Sidhu K, Chopra D, Costa F, Spena G, Berger T, Zelinsky D, Wheeler CJ, Ashford JW, Schulte R, Nezami MA, Kloor H, Filler A, Eliashiv DS, Sinha D, DeSalles AAF, Sadanand V, Suchkov S, Green K, Metin B, Hariri R, Cormier J, Yamamoto V, Kateb B. Neuroscience20 (BRAIN20, SPINE20, and MENTAL20) Health Initiative: A Global Consortium Addressing the Human and Economic Burden of Brain, Spine, and Mental Disorders Through Neurotech Innovations and Policies. J Alzheimers Dis 2021; 83:1563-1601. [PMID: 34487051 DOI: 10.3233/jad-215190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Neurological disorders significantly impact the world's economy due to their often chronic and life-threatening nature afflicting individuals which, in turn, creates a global disease burden. The Group of Twenty (G20) member nations, which represent the largest economies globally, should come together to formulate a plan on how to overcome this burden. The Neuroscience-20 (N20) initiative of the Society for Brain Mapping and Therapeutics (SBMT) is at the vanguard of this global collaboration to comprehensively raise awareness about brain, spine, and mental disorders worldwide. This paper aims to provide a comprehensive review of the various brain initiatives worldwide and highlight the need for cooperation and recommend ways to bring down costs associated with the discovery and treatment of neurological disorders. Our systematic search revealed that the cost of neurological and psychiatric disorders to the world economy by 2030 is roughly $16T. The cost to the economy of the United States is $1.5T annually and growing given the impact of COVID-19. We also discovered there is a shortfall of effective collaboration between nations and a lack of resources in developing countries. Current statistical analyses on the cost of neurological disorders to the world economy strongly suggest that there is a great need for investment in neurotechnology and innovation or fast-tracking therapeutics and diagnostics to curb these costs. During the current COVID-19 pandemic, SBMT, through this paper, intends to showcase the importance of worldwide collaborations to reduce the population's economic and health burden, specifically regarding neurological/brain, spine, and mental disorders.
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Affiliation(s)
- Kevin Morris
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA
| | - Mohammad Nami
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Iran.,Middle East Brain + Initiative, Los Angeles, CA, USA.,Neuroscience Center, Instituto de Investigaciones Científicas Servicios de Alta Tecnología, City of Knowledge, Panama City, Panama
| | - Joe F Bolanos
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA
| | - Maria A Lobo
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA
| | - Melody Sadri-Naini
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA
| | - John Fiallos
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA
| | - Gilberto E Sanchez
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA
| | - Teshia Bustos
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA
| | - Nikita Chintam
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA
| | - Marco Amaya
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA
| | - Susanne E Strand
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA
| | - Alero Mayuku-Dore
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA
| | - Indira Sakibova
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA
| | - Grace Maria Nicole Biso
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA
| | - Alejandro DeFilippis
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA
| | - Daniela Bravo
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA
| | - Nevzat Tarhan
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Middle East Brain + Initiative, Los Angeles, CA, USA.,Department of Psychiatry, Faculty of Medicine, Uskudar University, Istanbul, Turkey
| | - Carsten Claussen
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Fraunhofer-Institute for Translational Research and Pharmacology, Hamburg, Germany
| | - Alejandro Mercado
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Department of Neurosurgery, Hospital Military Regional Mendoza, Mendoza, Argentina
| | | | - Louis Yuge
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Division of Bio-Environment Adaptation Sciences, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan.,Cell Therapy Venture Company, Space Bio-Laboratories, Hiroshima, Japan
| | - Shigeo Okabe
- Brain Medical Science Collaboration Division, RIKEN Center for Brain Science Institution and Department: Cellular Neurobiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Konstantin Kotliar
- Department of Biomedical Engineering, Aachen University of Applied Sciences, Aachen, Germany
| | - Christina Sadowsky
- International Center for Spinal Cord Injury, Kennedy Krieger Institute-Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - P Sarat Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | | | - Vasileios Katsaros
- Department of Advanced Imaging Modalities, MRI Unit, General Anti-Cancer and Oncological Hospital of Athens "St. Savvas", Athens, Greece.,Departments of Neurosurgery and Neurology, National and Kapodistrian University of Athens, Athens, Greece.,Department of Neuroradiology, University College of London, London, UK
| | - Brian Mehling
- T-Neuro Pharma, Inc., Albuquerque, NM, USA.,StemVax LLC, Chesterland, OH, USA
| | - Maryam Noroozian
- Middle East Brain + Initiative, Los Angeles, CA, USA.,Cognitive Neurology and Neuropsychiatry Division, Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Kazem Abbasioun
- Middle East Brain + Initiative, Los Angeles, CA, USA.,Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Amirjamshidi
- Middle East Brain + Initiative, Los Angeles, CA, USA.,Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholam-Ali Hossein-Zadeh
- Middle East Brain + Initiative, Los Angeles, CA, USA.,National Brain Mapping Laboratory, Tehran, Iran
| | - Faridedin Naraghi
- Middle East Brain + Initiative, Los Angeles, CA, USA.,Iranian Society for Brain Mapping & Therapeutics, Tehran, Iran
| | - Mojtaba Barzegar
- Middle East Brain + Initiative, Los Angeles, CA, USA.,Intelligent Quantitative Bio-Medical Imaging, Tehran, Iran, and Medical Physics Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali A Asadi-Pooya
- Middle East Brain + Initiative, Los Angeles, CA, USA.,Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Sajad Sahab-Negah
- Middle East Brain + Initiative, Los Angeles, CA, USA.,Neuroscience Research Center, Mashhad University of Medical Sciences, Mashhad Iran.,Shefa Neuroscience Research Center, Khatam Alanbia Hospital, Tehran, Iran
| | - Saeid Sadeghian
- Middle East Brain + Initiative, Los Angeles, CA, USA.,Department of Pediatric Neurology, Golestan Medical, Educational, and Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Nesrin Dilbaz
- Department of Psychiatry, Faculty of Medicine, Uskudar University, Istanbul, Turkey
| | - Namath Hussain
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Loma Linda University, School of Medicine, Loma Linda, CA, USA
| | - Zoltan Mari
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Robert W Thatcher
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Applied Neuroscience Research Institute, St. Petersburg, FL, USA.,Applied Neuroscience, Inc., St. Petersburg, Fl, USA
| | - Daniel Sipple
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA.,Fraunhofer-Institute for Translational Research and Pharmacology, Hamburg, Germany
| | - Kuldip Sidhu
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA.,CK Cell Technologies Pty Ltd, Norwest, NSW, Australia.,Faculty of Medicine, Centre for Healthy Brain Ageing, University of New South Wales, Sydney, NSW, Australia.,Society for Brain Mapping and Therapeutics-Sydney, Sydney, NSW, Australia
| | | | - Francesco Costa
- IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | | | - Ted Berger
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,USC Department of Biomedical Engineering, Los Angeles, CA, USA
| | - Deborah Zelinsky
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,The Mind-Eye Institute, Northbrook, IL, USA
| | - Christopher J Wheeler
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Social Science Research Institute, Tokai University, Shibuya City, Tokyo, Japan
| | - J Wesson Ashford
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Reinhard Schulte
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Loma Linda University, School of Medicine, Loma Linda, CA, USA
| | - M A Nezami
- Sahel Oncology LLC, Newport Beach, CA, USA
| | - Harry Kloor
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Beyond Imagination, Los Angeles, CA, USA
| | - Aaron Filler
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA.,Institute for Nerve Medicine, Santa Monica, CA, USA
| | - Dawn S Eliashiv
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Department of Neurology, UCLA-David Geffen School of Medicine, Los Angeles, CA, USA
| | - Dipen Sinha
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA
| | - Antonio A F DeSalles
- Department of Neurosurgery, UCLA David Geffen School of Medicine, Los Angeles CA, USA.,NeuroSapiens - Rede D'Or São Luiz, Sao Paulo, Brazil.,Society for Brain Mapping and Therapeutics-Brazil, Sao Paulo, Brazil
| | - Venkatraman Sadanand
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA
| | - Sergey Suchkov
- Applied Neuroscience, Inc., St. Petersburg, Fl, USA.,Society for Brain Mapping and Therapeutics-Russia, Moscow, Russia
| | - Ken Green
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA
| | - Barish Metin
- Middle East Brain + Initiative, Los Angeles, CA, USA.,Department of Psychiatry, Faculty of Medicine, Uskudar University, Istanbul, Turkey
| | - Robert Hariri
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA.,Celularity Corporation, Warren, NJ, USA.,Weill Cornell School of Medicine, Department of Neurosurgery, New York, NY, USA
| | - Jason Cormier
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Blue Horizon International, Hackensack, NJ, USA
| | - Vicky Yamamoto
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA.,USC Keck School of Medicine, The USC Caruso Department of Otolaryngology-Head and Neck Surgery, Los Angeles, CA, USA.,USC-Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Babak Kateb
- Middle East Brain + Initiative, Los Angeles, CA, USA.,Loma Linda University, School of Medicine, Loma Linda, CA, USA.,National Center for Nanobioelectronics, Los Angeles, CA, USA.,Brain Technology and Innovation Park, Los Angeles, CA, USA
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7
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Hozumi A, Tagai K, Shinagawa S, Kamimura N, Shigenobu K, Kashibayashi T, Azuma S, Yoshiyama K, Hashimoto M, Ikeda M, Shigeta M, Kazui H. Clinical profiles of people with dementia exhibiting with neuropsychiatric symptoms admitted to mental hospitals: A multicenter prospective survey in Japan. Geriatr Gerontol Int 2021; 21:825-829. [PMID: 34310003 DOI: 10.1111/ggi.14248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/12/2021] [Accepted: 07/06/2021] [Indexed: 11/27/2022]
Abstract
AIMS Patients with severe behavioral and psychological symptoms of dementia (BPSD) are often admitted to mental hospitals, while, inpatient care could also lead to prolonged hospital stay. The present study aims to survey clinical profiles of patients who required inpatient treatment for BPSD, and then establish the criteria for introducing inpatient treatment through assessment by certified psychiatrists. METHODS We performed a prospective survey about clinical characteristics of people with dementia who required treatment of BPSD at 12 mental medical institutions. All patients were assessed by certified psychiatrists to determine the optimal treatment settings: outpatient or inpatient. The multivariate logistic regression analysis was performed to specify factors contributed to the judgement of clinicians. Subsequently, the receiver operating characteristic curve analysis was conducted to explore a score derived from the Neuropsychiatric Inventory to divide patients into outpatient or inpatient groups. RESULTS The present study included 386 patients, of which 242 were admitted to mental hospitals. BPSD were classified into four domains, and aggressive BPSD was significantly associated with assessment for inpatient treatment; the adjusted odds ratio was approximately 2 regardless of dementia severity. Furthermore, the composite score of agitation, irritability and aberrant behavior showed the highest area under the curve value (=0.706), which differentiated inpatients from outpatients with a sensitivity of 76% and a specificity of 54%. CONCLUSIONS Aggressive BPSD was the risk factor for inpatient treatment. The composite score of the Neuropsychiatric Inventory subdomain-related aggressive BPSD could be a screening tool to introduce inpatient treatment for BPSD. Geriatr Gerontol Int 2021; 21: 825-829.
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Affiliation(s)
- Asami Hozumi
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan.,Fukkokai Soubu Hospital, Chiba, Japan
| | - Kenji Tagai
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | | | - Naoto Kamimura
- Department of Neuropsychiatry, Kochi Medical School, Kochi University, Kochi, Japan
| | | | - Tetsuo Kashibayashi
- Department of Neuropsychiatry, Kochi Medical School, Kochi University, Kochi, Japan
| | - Shingo Azuma
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan.,Department of Psychiatry, Mizuma Hospital, Kaizuka, Japan
| | - Kenji Yoshiyama
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Mamoru Hashimoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Manabu Ikeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masahiro Shigeta
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroaki Kazui
- Department of Neuropsychiatry, Kochi Medical School, Kochi University, Kochi, Japan
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Nitrini R, Barbosa MT, Dozzi Brucki SM, Yassuda MS, Caramelli P. Current trends and challenges on dementia management and research in Latin America. J Glob Health 2021; 10:010362. [PMID: 32566153 PMCID: PMC7303806 DOI: 10.7189/jogh.10.010362] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Ricardo Nitrini
- Departamento de Neurologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Maira Tonidandel Barbosa
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Sonia Maria Dozzi Brucki
- Departamento de Neurologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Mônica Sanches Yassuda
- Departamento de Neurologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil.,Escola de Artes, Ciências e Humanidades da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Paulo Caramelli
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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9
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Maresova P, Komarkova L, Kuhnova J, Cimler R, Pazitny P, Kandilaki D, Musilek K, Truhlarova Z, Zemek F, Kuca K. Anticipated Social and Healthcare Economic Burden of People with Alzheimer's Disease in Two Selected Regions of the Czech Republic. Healthcare (Basel) 2020; 8:healthcare8040433. [PMID: 33114626 PMCID: PMC7712805 DOI: 10.3390/healthcare8040433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/12/2020] [Accepted: 10/17/2020] [Indexed: 12/17/2022] Open
Abstract
Increasing life expectancy in modern society is undoubtedly due to improved healthcare, scientific advances in medicine, and the overall healthy lifestyle of the general population. However, this positive trend has led to an increase in the number of older people with a growing need for a sustainable system for the long-term care of this part of the population, which includes social and health services that are essential for a high quality of life. Longevity also brings challenges in the form of a polymorbid geriatric population that places financial pressure on healthcare systems. Regardless, one disease dominates the debate about financial sustainability due to the increasing numbers of people diagnosed, and that is Alzheimer’s disease (AD). The presented paper aims to demonstrate the economic burden of social and healthcare services. Data from two regions in the Czech Republic were selected to demonstrate the potential scope of the problem. The future costs connected with AD are calculated by a prediction model, which is based on a population model for predicting the number of people with AD between 2020 and 2070. Based on the presented data from the two regions in the Czech Republic and the prediction model, several trends emerged. There appears to be a significant difference in the annual direct costs per person diagnosed with AD depending on the region in which they reside. This may lead to a significant inequality of the services a person can acquire followed by subsequent social issues that can manifest as a lower quality of life. Furthermore, given the prediction of the growing AD population, the costs expressed in constant prices based on the year 2020 will increase almost threefold during the period 2020–2070. The predicted threefold increase will place additional financial pressure on all stakeholders responsible for social and healthcare services, as the current situation is already challenging.
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Affiliation(s)
- Petra Maresova
- Department of Economics, Faculty of Informatics and Management, University of Hradec Kralove, Rokitanskeho 62, 50003 Hradec Kralove, Czech Republic;
| | - Lenka Komarkova
- Department of Exact Methods, Faculty of Management, Prague University of Economics and Business, Jarosovska 1117, 37701 Jindrichuv Hradec, Czech Republic;
| | - Jitka Kuhnova
- Centre of Advanced Technologies, Faculty of Science, University of Hradec Kralove, Rokitanskeho 62, 50003 Hradec Kralove, Czech Republic; (J.K.); (R.C.)
| | - Richard Cimler
- Centre of Advanced Technologies, Faculty of Science, University of Hradec Kralove, Rokitanskeho 62, 50003 Hradec Kralove, Czech Republic; (J.K.); (R.C.)
| | - Peter Pazitny
- Department of Management, Faculty of Management, Prague University of Economics and Business, Jarosovska 1117, 37701 Jindrichuv Hradec, Czech Republic; (P.P.); (D.K.)
| | - Daniela Kandilaki
- Department of Management, Faculty of Management, Prague University of Economics and Business, Jarosovska 1117, 37701 Jindrichuv Hradec, Czech Republic; (P.P.); (D.K.)
| | - Kamil Musilek
- Department of Chemistry, Centre of Advanced Technologies, Faculty of Science, University of Hradec Kralove, Rokitanskeho 62, 50003 Hradec Kralove, Czech Republic;
| | - Zuzana Truhlarova
- Department of Special Pedagogy, Faculty of Education, University of Hradec Kralove, Rokitanskeho 62, 50003 Hradec Kralove, Czech Republic;
| | - Filip Zemek
- Biomedical Research Centre, University Hospital Hradec Kralove, Sokolska 581, 50005 Hradec Kralove, Czech Republic;
| | - Kamil Kuca
- Department of Economics, Faculty of Informatics and Management, University of Hradec Kralove, Rokitanskeho 62, 50003 Hradec Kralove, Czech Republic;
- Biomedical Research Centre, University Hospital Hradec Kralove, Sokolska 581, 50005 Hradec Kralove, Czech Republic;
- Correspondence:
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10
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Maresova P, Lee S, Fadeyi OO, Kuca K. The social and economic burden on family caregivers for older adults in the Czech Republic. BMC Geriatr 2020; 20:171. [PMID: 32393190 PMCID: PMC7216393 DOI: 10.1186/s12877-020-01571-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 04/27/2020] [Indexed: 12/05/2022] Open
Abstract
Background In this paper, we analyse the economic burden of elder care in the Czech Republic by assessing how family members of senior citizens engage in caregiving. To do this, we examined the time and cost associated with caregiving as a function of age, gender, and income of the caregiver. Methods A questionnaire comprising 17 items was used to gather data from 155 informal caregivers whose seniors are affiliated with 200 registered home care agencies. Spearman rank correlation was adopted to analyse how caregivers’ income, age and gender influences the costs accrued and time spent in caring for elders. The expenses are divided into direct and indirect. Publicly available sources are used to establish expenses on treatment and medication, which cannot be determined by the questionnaire survey. Results Results show that around-the-clock care is the most common. Spouses of care recipients make up the highest number of caregivers, and women represent the largest portion of this group. Additionally, the more the time spent caring for an elder, the higher the cost associated with such care. The total annual burden of informal caregivers is determined by the sum of annual average indirect costs, amounting to € 36,888, and annual direct costs, amounting to € 2775, resulting in a total of € 39,663 per year. Conclusion Czech social policymakers should begin to consider better packages for caregivers in the form of incentives and other monetary benefits to improve living standards and care for ageing seniors.
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Affiliation(s)
- Petra Maresova
- Faculty of Informatics and Management, University of Hradec Kralove, Rokitanskeho 62, 50003, Hradec Kralove, Czech Republic
| | - Sunwoo Lee
- Faculty of Informatics and Management, University of Hradec Kralove, Rokitanskeho 62, 50003, Hradec Kralove, Czech Republic
| | - Oluwaseun Omolaja Fadeyi
- Department of Geology, Faculty of Geography and Geoscience, University of Trier, Universitätsring 15, 54296, Trier, Germany
| | - Kamil Kuca
- Faculty of Informatics and Management, University of Hradec Kralove, Rokitanskeho 62, 50003, Hradec Kralove, Czech Republic.
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Langoni CDS, Resende TDL, Barcellos AB, Cecchele B, Knob MS, Silva TDN, da Rosa JN, Diogo TDS, Filho IGDS, Schwanke CHA. Effect of Exercise on Cognition, Conditioning, Muscle Endurance, and Balance in Older Adults With Mild Cognitive Impairment: A Randomized Controlled Trial. J Geriatr Phys Ther 2020; 42:E15-E22. [PMID: 29738405 DOI: 10.1519/jpt.0000000000000191] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Mild cognitive impairment (MCI) may be a precursor to dementia; however, its progression may be prevented or slowed with exercise. This study aimed at determining the effects of group aerobic and strength training on cognition, conditioning, muscle endurance, and balance in underprivileged community-dwelling older adults with MCI. METHODS This was a single-blind, randomized, and matched-pair controlled (gender, age, body mass index, and Addenbrooke's Cognitive Examination-Revised for MCI diagnosis) clinical trial. It was developed in 4 community centers. Fifty-two sedentary, functionally independent individuals, aged 60 years or more, with MCI were randomized into intervention group (n = 26) and control group (n = 26). Participants were tested before and after a 24-week exercise program. Sociodemographic characteristics, cognition (Mini-Mental State Examination), conditioning (2-minute stationary walk test), lower-limb endurance (30-second sit/stand test), and balance data (Functional Reach test) were collected. The intervention group walked and exercised twice weekly (60 minutes each) using ankle weights, latex resistance bands, and dumbbells. The exercise load and intensity were regularly increased on the basis of a preestablished incremental number of sets and repetitions and on the basis of the participants' correct movement execution with a given load. Data were analyzed with Pearson χ test, Fisher exact test, Student t test, Mann-Whitney U test, 2-way repeated measures analysis of variance, and the Cohen d. RESULTS AND DISCUSSION Before the intervention, no significant differences were found between groups for any of the variables. Postintervention, significant differences were observed in cognition, conditioning, muscle endurance, and balance. Significant time-by-group interactions were detected in all the intergroup analyses. The improvements observed in the intervention group had medium to large effect sizes (0.35-1.15). The control group's decrease in cognition (13.9%) had a large effect size, while its Functional Reach test decrease (11.4%) had a medium effect size, with no significant change in conditioning or muscle endurance. CONCLUSION The training program improved cognitive function, muscle endurance, aerobic conditioning, and balance in older adults with MCI.
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Affiliation(s)
| | - Thais de Lima Resende
- School of Health Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Betina Cecchele
- School of Health Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Mateus Soares Knob
- School of Health Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Juliana Nunes da Rosa
- School of Health Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Tamiris de Souza Diogo
- School of Health Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
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12
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Swall A, Williams C, Marmstål Hammar L. The value of "us"-Expressions of togetherness in couples where one spouse has dementia. Int J Older People Nurs 2019; 15:e12299. [PMID: 31886633 PMCID: PMC7317469 DOI: 10.1111/opn.12299] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/13/2019] [Accepted: 11/29/2019] [Indexed: 11/27/2022]
Abstract
Background Living with dementia involves both illness and health, and self‐care and care from others. As most persons with dementia live in their own homes, dementia affects not only the person with the disease, but also family, commonly the partner. Research shows that spousal carers feel as though they are losing their partners since they can no longer share thoughts, feelings and experiences as a couple. Aim The aim of the study was to describe the sense of togetherness of the spouses when one spouse has dementia. Method The sample consists of 18 recorded conversations between 15 persons with dementia and their spouses. The filmed conversations were transcribed verbatim and then analysed using qualitative content analysis. Findings One overarching theme arose: Dementia preserved and challenged the value of “us.” It can be challenging for a couple in which one partner has dementia to preserve a sense of togetherness and to have the relationship they wish for. Conclusion Based on our results, we suggest that practitioners should help couples to strengthen their bond as a couple so as to maintain a sense of well‐being. Future studies should examine couplehood under differing conditions, such as long‐ versus short‐term relationships. Prior relationship quality may also be a factor that influences the sense of couplehood following a serious health challenge, such as dementia. Implication for practice When spouses were able to live together, their relationship was enriched at many levels. Their love for each other strengthened them as a unit – as an “us” – where togetherness seemed to be strong. Future studies need to examine whether the sense of couplehood varies depending on the length of the relationship (i.e., a relationship of many years or a relatively new relationship).
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Affiliation(s)
- Anna Swall
- School of Education, Health and Society, Dalarna University, Falun, Sweden
| | | | - Lena Marmstål Hammar
- School of Education, Health and Society, Dalarna University, Falun, Sweden.,Division of Nursing, Department of Neurobiology, Care Sciences, Karolinska Institute, Stockholm, Sweden.,Care and Social Welfare, School of Health, Mälardalen University, Västerås, Sweden
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13
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Szabo S, Lakzadeh P, Cline S, Palma Dos Reis R, Petrella R. The clinical and economic burden among caregivers of patients with Alzheimer's disease in Canada. Int J Geriatr Psychiatry 2019; 34:1677-1688. [PMID: 31353572 DOI: 10.1002/gps.5182] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 07/08/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To estimate the clinical and direct medical economic burden among Alzheimer disease (AD) caregivers using real-world, longitudinal patient-level data in Canada. METHODS/DESIGN This retrospective observational study assessed the clinical and direct medical economic burden among individuals who cohabitate with AD patients ("AD caregiver cohort") compared with older adults who were cohabiting with another adult without dementia ("comparison cohort") using real-world data from the Southwestern Ontario database, a representative Canadian electronic health record (EHR) longitudinal EHR. RESULTS The AD caregiver cohort (n = 2749; mild AD: n = 2254, moderate AD: n = 302, and severe AD, n = 193) had a similar or higher level of clinical and economic burden than the comparison cohort (n = 12 152). The overall AD cohort and caregivers of patients with mild AD had a similar clinical burden to the comparison cohort. Those caregiving for more severely affected AD patients had an increased risk of comorbidities and required more medication, physician attention, and hospital encounters compared with caregivers of less severe AD patients and the comparison cohort. Mean annual costs were higher among the AD caregiver cohort than the comparison cohort, and those caregiving for moderate and severe AD patients incurred the highest costs. Overall mortality was higher in the AD caregiver cohort compared with the comparison cohort. CONCLUSIONS Caregivers of patients with mild AD had a similar clinical and direct economic burden to older adults who were not dementia caregivers, whereas the burden among caregivers of moderate and severe AD patients was much greater.
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Affiliation(s)
| | | | | | | | - Robert Petrella
- Department of Family Practice, University of Western Ontario, London, ON, Canada
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14
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Kongpakwattana K, Dejthevaporn C, Krairit O, Dilokthornsakul P, Mohan D, Chaiyakunapruk N. A Real-World Evidence Analysis of Associations Among Costs, Quality of Life, and Disease-Severity Indicators of Alzheimer's Disease in Thailand. Value Health 2019; 22:1137-1145. [PMID: 31563256 DOI: 10.1016/j.jval.2019.04.1937] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 04/17/2019] [Accepted: 04/25/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Although an increase in the burden of Alzheimer's disease (AD) is evident worldwide, knowledge of costs and health-related quality of life (HRQOL) associated with AD in low- and middle-income countries is still lacking. OBJECTIVES This study aimed to collect real-world cost and HRQOL data, and investigate their associations with multiple disease-severity indicators among AD patients in Thailand. METHODS We recruited AD patients aged ≥60 years accompanied by their caregivers at a university-affiliated tertiary hospital. A one-time structured interview was conducted to collect disease-severity indicators, HRQOL, and caregiving information using standardized tools. The hospital's database was used to retrieve healthcare resource utilization occurred over 6 months preceding the interview date. Costs were annualized and stratified based on cognitive status. Generalized linear models were employed to evaluate determinants of costs and HRQOL. RESULTS Among 148 community-dwelling patients, average annual total societal costs of AD care were $8014 (95% confidence interval [CI]: $7295-$8844) per patient. Total costs of patients with severe stage ($9860; 95% CI: $8785-$11 328) were almost twice as high as those of mild stage ($5524; 95% CI: $4649-$6593). The major cost driver was direct medical costs, particularly those incurred by AD prescriptions. Functional status was the strongest determinant for both total costs and patient's HRQOL (P value <.001). CONCLUSION Our real-world findings suggest the distinct major cost driver that results from expensive AD treatment, emphasizing the demand of country-specific cost evidence. Increases in cognitive and functional status are significantly associated with decreases in total costs of AD care and improvement in patient's HRQOL.
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Affiliation(s)
- Khachen Kongpakwattana
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia; Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia
| | - Charungthai Dejthevaporn
- Division of Neurology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Orapitchaya Krairit
- Division of Geriatric Medicine, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Piyameth Dilokthornsakul
- Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Naresuan University, Phitsanulok, Thailand
| | - Devi Mohan
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia; College of Pharmacy, University of Utah, Salt Lake City, UT, USA.
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Ricci G. Social Aspects of Dementia Prevention from a Worldwide to National Perspective: A Review on the International Situation and the Example of Italy. Behav Neurol 2019; 2019:8720904. [PMID: 31583024 PMCID: PMC6754867 DOI: 10.1155/2019/8720904] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 08/05/2019] [Accepted: 08/23/2019] [Indexed: 11/17/2022] Open
Abstract
At the moment, dementia is affecting around 47 million people worldwide, with a forecast amount of 135 million affected people in 2050. Dementia is a growing health concern worldwide with no treatment currently available, but only symptomatic medication. Effective interventions in the prevention and management of dementia are urgently needed to contain direct and indirect costs of this disease. Indeed, the economic impact of dementia is a vast and continually growing figure, but it is still difficult to quantify. Due to an increase in both the disease spreading and its direct and indirect costs, national and international action plans have to be implemented. As a virtuous example, the Italian national plan for dementia has been summarized. Faced with an increasingly less sustainable disease impact at national and international levels, the plan suggests that it is certainly the entire welfare model that should be rethought, strengthening the network of services and providing interventions to support affected people and their caregivers. Alongside this synergistic approach, scientific research could play a crucial role for pharmacological and nonpharmacological treatments capable of delaying the state of loss of self-sufficiency of the patient, with a significant impact on social and health costs.
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Hudomiet P, Hurd MD, Rohwedder S. The Relationship Between Lifetime Out-of-pocket Medical Expenditures, Dementia, and Socioeconomic Status in the U.S. J Econ Ageing 2018; 14:100181. [PMID: 31763164 PMCID: PMC6874215 DOI: 10.1016/j.jeoa.2018.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Dementia is one of the most expensive medical conditions. The costs are borne by families, by private insurance and by society via public programs such as Medicaid in the U.S.. There is extensive research on the relationship between dementia and annual medical spending. This paper, instead, estimates cumulative lifetime medical expenditures that can be attributed to the onset of dementia using a nationally representative longitudinal survey from the U.S., the Health and Retirement Study. The lifetime expenditures are estimated by summing any out-of-pocket medical spending reported in the panel from age 65 to death. Censored cases are imputed using a non-parametric matching algorithm called splicing. For example, survivors to the most recent wave are matched to similar individuals from older cohorts who are observed at the relevant ages all the way through death. We find that those who live with dementia for at least half a year pay, on average, $38,540 more out of pocket from age 65 to death when controlling for length of life, demographics, lifetime earnings and comorbidities. The costs of dementia are almost exclusively due to spending on nursing homes. Spending on drugs, doctor visits or hospitals, is not significantly related to dementia. The lifetime costs of dementia are significantly larger for white and rich individuals, perhaps because they use higher quality nursing homes and because they have more financial resources to spend down before becoming eligible for Medicaid support.
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17
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Nakabe T, Sasaki N, Uematsu H, Kunisawa S, Wimo A, Imanaka Y. The personal cost of dementia care in Japan: A comparative analysis of residence types. Int J Geriatr Psychiatry 2018; 33:1243-1252. [PMID: 29892984 DOI: 10.1002/gps.4916] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 04/13/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We aimed to quantify the personal economic burden of dementia care in Japan according to residence type. METHODS A cross-sectional online survey was conducted on 3841 caregivers of people with dementia. An opportunity cost approach was used to calculate informal care costs. All costs and the observed/expected (OE) ratio of costs were adjusted using patient sex, age, and care-needs levels, and compared among the residence types. RESULTS The mean daily informal care time was 8.2 hours, and the mean monthly informal care costs for community-dwelling people with dementia were US$1559. The OE ratio for informal care costs in community-dwelling patients was higher than in institutionalized patients. CONCLUSION The inclusion of informal care costs reduced the differences in total personal costs among the residence types. The economic burden of informal care should be considered when quantifying dementia care costs.
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Affiliation(s)
- Takayo Nakabe
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, Japan
| | - Noriko Sasaki
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, Japan
| | - Hironori Uematsu
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, Japan
| | - Susumu Kunisawa
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, Japan
| | - Anders Wimo
- Aging Research Centre, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, Japan
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18
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Ferretti C, Sarti FM, Nitrini R, Ferreira FF, Brucki SMD. An assessment of direct and indirect costs of dementia in Brazil. PLoS One 2018; 13:e0193209. [PMID: 29494693 PMCID: PMC5832239 DOI: 10.1371/journal.pone.0193209] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 02/06/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To analyze costs associated with dementia based on a cross-sectional study in the Brazilian health system. METHODS Direct and indirect costs were estimated by conducting comprehensive interviews on the use of resources in a sample of 156 patients with dementia treated at an outpatient memory clinic of a tertiary hospital. A regression model was used to determine the main determinants of costs associated with dementia. RESULTS Global costs of dementia were US$1,012.35; US$1,683.18 and US$1,372.30 per patient/month for mild, moderate and severe stages, respectively. Indirect costs ranged from US$536.62 to US$545.17 according to severity. Dementia costs were influenced by medication, FAST score, and educational level of caregiver. DISCUSSION The study represents an original contribution toward establishing direct and indirect costs of dementia in Brazil. Results indicate significant economic impacts, including projection of annual costs of US$16,548.24 per patient.
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Affiliation(s)
- Ceres Ferretti
- Department of Neurology, Cognitive and Behavioral Neurology Unit, School of Medicine, Universidade de São Paulo, SP—Brazil
- Department of Nursing and Nutrition of Universidade de Taubaté, Taubaté—São Paulo Brazil
| | - Flávia M. Sarti
- Universidade de São Paulo, USP Leste, Escola de Artes, Ciências e Humanidades, São Paulo, SP—Brasil
| | - Ricardo Nitrini
- Department of Neurology, Cognitive and Behavioral Neurology Unit, School of Medicine, Universidade de São Paulo, SP—Brazil
| | - Fernando F. Ferreira
- Universidade de São Paulo, USP Leste, Escola de Artes, Ciências e Humanidades, São Paulo, SP—Brasil
| | - Sonia M. D. Brucki
- Department of Neurology, Cognitive and Behavioral Neurology Unit, School of Medicine, Universidade de São Paulo, SP—Brazil
- Hospital Santa Marcelina, São Paulo, SP—Brasil
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Li X, Jiang X, Sun J, Zhu C, Bai W. Recent advances of medical foods in China: The opportunities and challenges under standardization. Food Chem Toxicol 2018; 119:342-354. [PMID: 29452191 DOI: 10.1016/j.fct.2018.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 02/06/2018] [Accepted: 02/08/2018] [Indexed: 12/24/2022]
Abstract
Malnutrition with high incidence in hospitalized patients in China has brought a significant burden of disease. Although many clinical studies have demonstrated the importance of nutritional for patients with malnutrition, the application of medical foods in China is still restricted. For the classification, limits, production and registration of medical foods, the Chinese government newly enacted a series of regulations. In this review, comparing the policy, researches, and product variety of medical foods in China with other countries, although the current status of the development of medical foods in China is still far behind that of developed countries, some of regulations are stricter than those of many other countries or organizations. The medical foods in China are divided into four categories, the nutrients and environmental contaminants are limited to ensure the safety. As a prospect, the development of medical foods in China is expected to get out of the predicament of lack of emphasis, shortage of supply, backward of local processing technology and the imperfect management system. After all, in view of the huge population and the increasing demand of nutrition in China, there must be a very good prospect for the future development of the medical foods industry in China.
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Affiliation(s)
- Xusheng Li
- Department of Food Science and Engineering, Institute of Food Safety and Nutrition, Guangdong Engineering Technology Center of Food Safety Molecular Rapid Detection, Jinan University, Guangzhou 510632, PR China
| | - Xinwei Jiang
- Department of Food Science and Engineering, Institute of Food Safety and Nutrition, Guangdong Engineering Technology Center of Food Safety Molecular Rapid Detection, Jinan University, Guangzhou 510632, PR China
| | - Jianxia Sun
- School of Chemical Engineering and Light Industry, Guangdong University of Technology, Guangzhou 510090, PR China
| | - Cuijuan Zhu
- Department of Food Science and Engineering, Institute of Food Safety and Nutrition, Guangdong Engineering Technology Center of Food Safety Molecular Rapid Detection, Jinan University, Guangzhou 510632, PR China
| | - Weibin Bai
- Department of Food Science and Engineering, Institute of Food Safety and Nutrition, Guangdong Engineering Technology Center of Food Safety Molecular Rapid Detection, Jinan University, Guangzhou 510632, PR China.
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Jia J, Wei C, Chen S, Li F, Tang Y, Qin W, Zhao L, Jin H, Xu H, Wang F, Zhou A, Zuo X, Wu L, Han Y, Han Y, Huang L, Wang Q, Li D, Chu C, Shi L, Gong M, Du Y, Zhang J, Zhang J, Zhou C, Lv J, Lv Y, Xie H, Ji Y, Li F, Yu E, Luo B, Wang Y, Yang S, Qu Q, Guo Q, Liang F, Zhang J, Tan L, Shen L, Zhang K, Zhang J, Peng D, Tang M, Lv P, Fang B, Chu L, Jia L, Gauthier S. The cost of Alzheimer's disease in China and re-estimation of costs worldwide. Alzheimers Dement 2018; 14:483-491. [PMID: 29433981 DOI: 10.1016/j.jalz.2017.12.006] [Citation(s) in RCA: 326] [Impact Index Per Article: 54.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 11/06/2017] [Accepted: 12/07/2017] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The socioeconomic costs of Alzheimer's disease (AD) in China and its impact on global economic burden remain uncertain. METHODS We collected data from 3098 patients with AD in 81 representative centers across China and estimated AD costs for individual patient and total patients in China in 2015. Based on this data, we re-estimated the worldwide costs of AD. RESULTS The annual socioeconomic cost per patient was US $19,144.36, and total costs were US $167.74 billion in 2015. The annual total costs are predicted to reach US $507.49 billion in 2030 and US $1.89 trillion in 2050. Based on our results, the global estimates of costs for dementia were US $957.56 billion in 2015, and will be US $2.54 trillion in 2030, and US $9.12 trillion in 2050, much more than the predictions by the World Alzheimer Report 2015. DISCUSSION China bears a heavy burden of AD costs, which greatly change the estimates of AD cost worldwide.
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Affiliation(s)
- Jianping Jia
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Geriatric Cognitive Disorders, Beijing, China; Center of Alzheimer's Disease, Beijing Institute for Brain Disorders, Beijing, China; Key Laboratory of Neurodegenerative Diseases, Ministry of Education, Beijing, China; National Clinical Research Center for Geriatric Disorders, Beijing, China.
| | - Cuibai Wei
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China.
| | - Shuoqi Chen
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Fangyu Li
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Yi Tang
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Wei Qin
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Lina Zhao
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Hongmei Jin
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Hui Xu
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Fen Wang
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Aihong Zhou
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Xiumei Zuo
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Liyong Wu
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Ying Han
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Yue Han
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Liyuan Huang
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Qi Wang
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Dan Li
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Changbiao Chu
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Lu Shi
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Min Gong
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Yifeng Du
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Jiewen Zhang
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Junjian Zhang
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Chunkui Zhou
- Department of Neurology, The First Teaching Hospital of Jilin University, Changchun, China
| | - Jihui Lv
- Dementia Unit, Beijing Geriatric Hospital, Beijing, China
| | - Yang Lv
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haiqun Xie
- Department of Neurology, Affiliated Foshan Hospital of Sun Yat-sen University, Foshan, China
| | - Yong Ji
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Fang Li
- Department of Gerontology, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Enyan Yu
- Department of Psychiatry, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Benyan Luo
- Department of Neurology, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Yanjiang Wang
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Shanshan Yang
- Department of Neurology, Daqing Oilfield General Hospital, Daqing, China
| | - Qiumin Qu
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qihao Guo
- Department of Neurology and Institute of Neurology, Huashan Hospital Fudan University, Shanghai, China
| | - Furu Liang
- Department of Neurology, Baotou Central Hospital, Baotou, China
| | - Jintao Zhang
- Department of Neurology, The 88th Hospital of PLA, Taian, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China
| | - Lu Shen
- Department of Neurology, Xiangya Hospital Central South University, Changsha, China
| | - Kunnan Zhang
- Department of Neurology, People's Hospital of Jiangxi Province, Nanchang, China
| | - Jinbiao Zhang
- Department of Neurology, Weihai Municipal Hospital, Weihai, China
| | - Dantao Peng
- Department of Neurology, Center for Geriatric Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Muni Tang
- Department of Geriatric Psychiatric, Guangzhou Huiai Hospital, Guangzhou, China
| | - Peiyuan Lv
- Department of Neurology, Hebei General Hospital, Shijiazhuang, China
| | - Boyan Fang
- Department of Neurology, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing, China
| | - Lan Chu
- Department of Neurology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Longfei Jia
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
| | - Serge Gauthier
- McGill Centre for Studies in Aging, McGill University, Montreal, Canada.
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Custodio N, Wheelock A, Thumala D, Slachevsky A. Dementia in Latin America: Epidemiological Evidence and Implications for Public Policy. Front Aging Neurosci 2017; 9:221. [PMID: 28751861 PMCID: PMC5508025 DOI: 10.3389/fnagi.2017.00221] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 06/23/2017] [Indexed: 01/20/2023] Open
Abstract
Population aging is among the most important global transformations. Today, 12% of the world population is of age 60 and over and by the middle of this century this segment will represent 21.5%. The increase in population of those aged 80 and over, also referred to as the "oldest old" or the "very elderly", will be even more pronounced, going from 1.7% of the population to 4.5% within the same period. Compared to European and North American countries, Latin America (LA) is experiencing this unprecedented demographic change at a significantly faster rate. Due to demographic and health transitions, the number of people with dementia will rise from 7.8 million in 2013 to over 27 million by 2050. Nowadays, the global prevalence of dementia in LA has reached 7.1%, with Alzheimer's Disease (AD) being the most frequent type. This level is similar to those found in developed countries; however, the dementia rate is twice as high as that of the 65-69 years age group in developed countries. In addition, the prevalence and incidence of dementia is higher among illiterate people. Mortality rates due to dementia have risen considerably. The burden and costs of the disease are high and must be covered by patients' families. The prevention of dementia and the development of long-term care policies and plans for people with dementia in LA, which take into account regional differences and similarities, should be urgent priorities.
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Affiliation(s)
- Nilton Custodio
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Departamento de Neurología, Instituto Peruano de NeurocienciasLima, Peru
| | - Ana Wheelock
- Gerosciences Center for Brain Health and Metabolism (GERO)Santiago, Chile.,Department of Surgery and Cancer, National Institute for Health Research Imperial Patient Safety Translational Research Centre, Imperial College LondonLondon, United Kingdom
| | - Daniela Thumala
- Gerosciences Center for Brain Health and Metabolism (GERO)Santiago, Chile.,Psychology Department, Faculty of Social Sciences, Universidad de ChileSantiago, Chile
| | - Andrea Slachevsky
- Gerosciences Center for Brain Health and Metabolism (GERO)Santiago, Chile.,Physiopathology Department, ICBM, and East Neuroscience Department, Faculty of Medicine, Universidad de ChileSantiago, Chile.,Cognitive Neurology and Dementia Unit, Neurology Department, Hospital del SalvadorSantiago, Chile.,Center for Advanced Research in Education (CIAE), Universidad de ChileSantiago, Chile.,Servicio de Neurología, Departamento de Medicina, Clínica Alemana-Universidad del DesarrolloSantiago, Chile
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Hojman DA, Duarte F, Ruiz-Tagle J, Budnich M, Delgado C, Slachevsky A. The cost of dementia in an unequal country: The case of Chile. PLoS One 2017; 12:e0172204. [PMID: 28267795 PMCID: PMC5340351 DOI: 10.1371/journal.pone.0172204] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 02/01/2017] [Indexed: 11/18/2022] Open
Abstract
We study the economic cost of dementia in Chile, and its variation according to socioeconomic status (SES). We use primary data from a survey of 330 informal primary caregivers who completed both a RUD-Lite and a socio-demographic questionnaire to evaluate the severity of dementia and caregiver's burden. The costs of dementia are broken into three components: direct medical costs (medical care, drugs, tests); direct social costs (social service, daycare); and indirect costs (mostly associated to informal care). The average monthly cost per patient is estimated at US$ 1,463. Direct medical costs account for 20 per cent, direct social costs for 5 per cent and indirect costs for 75 per cent of the total cost. The mean monthly cost is found to be inversely related to SES, a pattern largely driven by indirect costs. The monthly cost for high SES is US$ 1,083 and US$ 1,588 for low SES. A multivariate regression analysis suggests that severity of dementia and caregiver's burden account for between 49 and 70 per cent of the difference in the indirect cost across SES. However, between one-third and one-half of the variation across SES is not due to gradient in severity of dementia. Direct medical costs increase in higher SES, reflecting differences in purchasing power, while indirect costs are inversely related to SES and more than compensate differences in medical costs. Moreover, in lower SES groups, female caregivers, typically family members who are inactive in the labor market, mostly provide informal care. The average annual cost of dementia in Chile (US$ 17,559) is lower in comparison to high-income countries (US$ 39,595) and the proportion of cost related to informal cost is higher (74 per cent compared to 40 per cent). SES is a key determinant in the cost of dementia. In the absence of universal access to treatment, part of the social cost of dementia potentially preserves or increases income and gender inequality.
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Affiliation(s)
- Daniel A. Hojman
- Department of Economics, Faculty of Economics and Business, University of Chile, Santiago, Chile
- Centre for Social Conflict and Cohesion Studies, Santiago, Chile
| | - Fabian Duarte
- Department of Economics, Faculty of Economics and Business, University of Chile, Santiago, Chile
- Centre for Social Conflict and Cohesion Studies, Santiago, Chile
| | - Jaime Ruiz-Tagle
- Department of Economics, Faculty of Economics and Business, University of Chile, Santiago, Chile
| | - Marilu Budnich
- Centro KINTUN, Servicio de Salud Metropolitano Oriente, Santiago, Chile
| | - Carolina Delgado
- Neurology and Neurosurgery Department, Hospital Clínico Universidad de Chile, Santiago, Chile
- Neurology and Neurosurgery Department, Clínica Santa María, Santiago, Chile
| | - Andrea Slachevsky
- Physiopathology Department, ICBM and East Neuroscience Department, Faculty of Medicine, University of Chile, Santiago, Chile
- Gerosciences Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Cognitive Neurology and Dementia, Neurology Department, Hospital del Salvador, Santiago, Chile
- Neurology Service, Medicine Department, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
- Centre for Advanced Research in Education, Santiago, Chile
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Wimo A, Guerchet M, Ali GC, Wu YT, Prina AM, Winblad B, Jönsson L, Liu Z, Prince M. The worldwide costs of dementia 2015 and comparisons with 2010. Alzheimers Dement 2016; 13:1-7. [PMID: 27583652 PMCID: PMC5232417 DOI: 10.1016/j.jalz.2016.07.150] [Citation(s) in RCA: 643] [Impact Index Per Article: 80.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 07/11/2016] [Accepted: 07/27/2016] [Indexed: 11/25/2022]
Abstract
Introduction In 2010, Alzheimer's Disease International presented estimates of the global cost of illness (COI) of dementia. Since then, new studies have been conducted, and the number of people with dementia has increased. Here, we present an update of the global cost estimates. Methods This is a societal, prevalence-based global COI study. Results The worldwide costs of dementia were estimated at United States (US) $818 billion in 2015, an increase of 35% since 2010; 86% of the costs occur in high-income countries. Costs of informal care and the direct costs of social care still contribute similar proportions of total costs, whereas the costs in the medical sector are much lower. The threshold of US $1 trillion will be crossed by 2018. Discussion Worldwide costs of dementia are enormous and still inequitably distributed. The increase in costs arises from increases in numbers of people with dementia and in increases in per person costs. The worldwide costs of dementia were estimated at United States (US) $818 billion in 2015. This estimated worldwide costs represent an increase of 35% since 2010. Eighty-six percent of the costs occur in high-income countries. Costs of informal care and the direct costs of social care still contribute similar proportions of total costs, whereas the costs in the medical sector are much lower. The threshold of US $1 trillion will be crossed by 2018.
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Affiliation(s)
- Anders Wimo
- Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Stockholm University, Stockholm, Sweden; Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden; Centre for Research and Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden.
| | - Maëlenn Guerchet
- King's College London, The Global Observatory for Ageing and Dementia Care, Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, London, UK
| | - Gemma-Claire Ali
- King's College London, The Global Observatory for Ageing and Dementia Care, Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, London, UK
| | - Yu-Tzu Wu
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Life and Environment Sciences, Department of Psychology, University of Exeter, Exeter, UK
| | - A Matthew Prina
- King's College London, The Global Observatory for Ageing and Dementia Care, Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, London, UK
| | - Bengt Winblad
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
| | - Linus Jönsson
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
| | - Zhaorui Liu
- Institute of Mental Health, Peking University, Beijing, China
| | - Martin Prince
- King's College London, The Global Observatory for Ageing and Dementia Care, Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, London, UK
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Marešová P, Zahálková V. The economic burden of the care and treatment for people with Alzheimer's disease: the outlook for the Czech Republic. Neurol Sci 2016; 37:1917-1922. [PMID: 27470305 DOI: 10.1007/s10072-016-2679-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 07/18/2016] [Indexed: 11/30/2022]
Abstract
The aim of this paper is to specify the cost of treatment and care for people with Alzheimer's disease (AD) in the Czech Republic and also with a view to the future. Data availability is evaluated as well as the quality of cost comparison with other developed countries. Data for the Czech Republic will include data from the health insurance company regarding medicines and treatment, as well as a selected home caring for people with dementia and, ultimately, the Social Security Administration. The basic methods include an analysis of data from publicly available sources, direct interviews with the representatives of nursing homes caring for people with dementia and the representative of the Social Security Administration of the Czech Republic. Items will be specified within the category of direct costs. For the study, the indirect costs related to the loss of patient as well as caring person productivity are not considered. Costs for treatment and care are based from the data on 4162 patients, the costs of a bed from data on 391 beds in homes for the elderly. The average annual cost per patient with AD in the Czech Republic was calculated and came to the amount of 12,783 EUR. These items include outpatient care, inpatient care in a medical facility, inpatient care in homes and medications. In terms of share of these items on the direct costs, the largest item are services provided by special homes which contributes to the direct costs by 94 %, medications create 1 % and treatment (both outpatient and inpatient) 5 %. In the case of home care the total costs are lower at 4698 EUR. The Czech Republic as well as other developed countries are faced with the problem of unified accounting cost of people suffering from Alzheimer's disease. This then causes the calculation of the economic burden to be very difficult and indicative values.
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Affiliation(s)
- Petra Marešová
- Department of Economy, Faculty of Informatics and Management, University of Hradec Kralove, Rokitanskeho 62, 50003, Hradec Kralove, Czech Republic.
| | - Veronika Zahálková
- Department of Economy, Faculty of Informatics and Management, University of Hradec Kralove, Rokitanskeho 62, 50003, Hradec Kralove, Czech Republic
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Abstract
The present study evaluated the dementia risk after carbon monoxide poisoning (CO poisoning). Using the National Health Insurance Research Database of Taiwan, a total of 9041 adults newly diagnosed with CO poisoning from 2000 to 2011 were identified as the CO poisoning cohort. Four-fold (N = 36,160) of non-CO poisoning insured people were randomly selected as controls, frequency-matched by age, sex, and hospitalization year. Incidence and hazard ratio (HR) of dementia were measured by the end 2011. The dementia incidence was 1.6-fold higher in the CO exposed cohort than in the non-exposed cohort (15.2 vs 9.76 per 10,000 person-years; n = 62 vs 174) with an adjusted HR of 1.50 (95% CI = 1.11-2.04). The sex- and age-specific hazards were higher in male patients (adjusted HR = 1.74, 95% CI = 1.20-2.54), and those aged <= 49 years (adjusted HR = 2.62, 95% CI = 1.38-4.99). CO exposed patients with 7-day or longer hospital stay had an adjusted HR of 2.18 (95% CI = 1.42, 3.36). The CO poisoning patients on hyperbaric oxygen (HBO2) therapy had an adjusted HR of 1.80 (95% CI = 0.96-3.37). This study suggests that CO poisoning may have association with the risk of developing dementia, which is significant for severe cases. The effectiveness of HBO2 therapy remains unclear in preventing dementia. Patients with CO poisoning are more prevalent with depression.
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Affiliation(s)
- Ching-Yuan Lai
- From the Department of Emergency Medicine, China Medical University Hospital, Taichung (C-YL); Department of Critical Care Medicine, E-DA Hospital, Department of Community Medicine, E-DA Hospital and I-Shou University Kaohsiung (Y-WH), Department of Neurology, China Medical University Hospital (C-HT), Management Office for Health Data China Medical University Hospital (C-LL), College of Medicine (C-LL), Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine (C-HK), Department of Health Services Administration (F-CS); and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan (C-HK)
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Roppolo M, Kunnen ES, van Geert PL, Mulasso A, Rabaglietti E. A quantitative dynamic systems model of health-related quality of life among older adults. Clin Interv Aging 2015; 10:1755-70. [PMID: 26604722 PMCID: PMC4631406 DOI: 10.2147/cia.s91605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Health-related quality of life (HRQOL) is a person-centered concept. The analysis of HRQOL is highly relevant in the aged population, which is generally suffering from health decline. Starting from a conceptual dynamic systems model that describes the development of HRQOL in individuals over time, this study aims to develop and test a quantitative dynamic systems model, in order to reveal the possible dynamic trends of HRQOL among older adults. The model is tested in different ways: first, with a calibration procedure to test whether the model produces theoretically plausible results, and second, with a preliminary validation procedure using empirical data of 194 older adults. This first validation tested the prediction that given a particular starting point (first empirical data point), the model will generate dynamic trajectories that lead to the observed endpoint (second empirical data point). The analyses reveal that the quantitative model produces theoretically plausible trajectories, thus providing support for the calibration procedure. Furthermore, the analyses of validation show a good fit between empirical and simulated data. In fact, no differences were found in the comparison between empirical and simulated final data for the same subgroup of participants, whereas the comparison between different subgroups of people resulted in significant differences. These data provide an initial basis of evidence for the dynamic nature of HRQOL during the aging process. Therefore, these data may give new theoretical and applied insights into the study of HRQOL and its development with time in the aging population.
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Affiliation(s)
- Mattia Roppolo
- Department of Psychology, University of Torino, Torino, Italy
- Department of Developmental Psychology, Rijksuniversiteit of Groningen, Groningen, Netherlands
| | - E Saskia Kunnen
- Department of Developmental Psychology, Rijksuniversiteit of Groningen, Groningen, Netherlands
| | - Paul L van Geert
- Department of Developmental Psychology, Rijksuniversiteit of Groningen, Groningen, Netherlands
| | - Anna Mulasso
- Department of Psychology, University of Torino, Torino, Italy
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Yu X, Chen S, Chen X, Jia J, Li C, Liu C, Toumi M, Milea D. Clinical management and associated costs for moderate and severe Alzheimer's disease in urban China: a Delphi panel study. Transl Neurodegener 2015; 4:15. [PMID: 26301090 PMCID: PMC4546035 DOI: 10.1186/s40035-015-0038-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 08/09/2015] [Indexed: 11/10/2022] Open
Abstract
Background Healthcare resource utilisation for Alzheimer’s disease (AD) in China is not well understood. This Delphi panel study aimed to describe the clinical management pathways for moderate and severe AD patients in urban China and to define the amount and cost of healthcare resources used. Methods A panel of 11 experts was recruited from urban China to participate in two rounds of preparatory interviews. In the first round, 9 physicians specialised in dementia gave a qualitative description of the clinical management of AD patients. In the second round, 2 hospital administrators were asked about the cost of AD management and care. Results from the interviews were discussed by the experts in a Delphi panel meeting, where consensus was reached on quantitative aspects of AD management, including the rate of healthcare resource utilisation, the respective unit costs and caregiving time. Results Interviewees reported that mild AD is under-recognised in China; most patients are diagnosed with moderate to severe AD. Loss of independence and agitation/aggression are the main drivers for healthcare resource utilisation and contribute to a heavier caregiver burden. It was estimated that 70 % moderate AD patients are independent/non-aggressive at the time of diagnosis, 15 % are independent/aggressive, 10 % are dependent/non-aggressive, and 5 % are dependent/aggressive. Dependent/aggressive AD patients are more likely to be hospitalised (70–90 %) than accepted in a nursing home (0–20 %), while the opposite is true for dependent/non-aggressive patients (5–35 % for hospitalisation vs. 80 % for nursing home). Independent AD patients require 1–3 hours/day of caregiver time, while dependent patients can require up to 12–15 hours/day. Experts agreed that AD complicates the management of age-related comorbidities, found in 70–80 % of all AD patients, increasing the frequency and cost of hospitalisation. Conclusions The Delphi panel approach was an efficient method of gathering data about the amount of healthcare resources used and associated costs for moderate and severe AD patients in urban China. The results of this study provide a useful source of information for decision makers to improve future healthcare policies and resource planning, as well as to perform economic evaluations of AD therapies.
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Affiliation(s)
- Xin Yu
- Institute of Mental Health, Peking University Sixth Hospital, Huayuanbeilu 51, Haidian District, Beijing, 100191 China
| | - Shengdi Chen
- Department of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaochun Chen
- Fujian Institute of Geriatrics, Union Hospital of Fujian Medical University, Fuzhou, China
| | - Jianjun Jia
- Department of Geriatric Neurology, Chinese PLA General Hospital, Beijing, China
| | - Chunhou Li
- Medical Services Department, Peking Union Medical College Hospital, Beijing, China
| | - Cong Liu
- Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Turró-Garriga O, Calvó-Perxas L, Albaladejo R, Alsina E, Cuy J, Llinàs-Reglà J, Roig A, Serena J, Vallmajó N, Viñas M, López-Pousa S, Vilalta-Franch J, Garre-Olmo J. Pharmaceutical consumption and cost in patients with dementia: A longitudinal study by the Registry of Dementias of Girona (ReDeGi) in Catalonia (Spain). Arch Gerontol Geriatr 2015; 60:448-52. [PMID: 25716011 DOI: 10.1016/j.archger.2015.01.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 09/30/2014] [Accepted: 01/29/2015] [Indexed: 10/24/2022]
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Custodio N, Lira D, Herrera-Perez E, Del Prado LN, Parodi J, Guevara-Silva E, Castro-Suarez S, Montesinos R. Cost-of-illness study in a retrospective cohort of patients with dementia in Lima, Peru. Dement Neuropsychol 2015; 9:32-41. [PMID: 29213939 PMCID: PMC5618989 DOI: 10.1590/s1980-57642015dn91000006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Dementia is a major cause of dependency and disability among older persons, and
imposes huge economic burdens. Only a few cost-of-illness studies for dementia
have been carried out in middle and low-income countries.
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Affiliation(s)
- Nilton Custodio
- Servicio de Neurología, Clínica Internacional, Lima, Peru.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru.,Servicio de Neurología. Instituto Peruano de Neurociencias, Lima, Peru
| | - David Lira
- Servicio de Neurología, Clínica Internacional, Lima, Peru.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru.,Servicio de Neurología. Instituto Peruano de Neurociencias, Lima, Peru
| | - Eder Herrera-Perez
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru.,Centro de Investigación para el Desarrollo Integral y Sostenible (CIDIS), Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Liza Nuñez Del Prado
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru.,Servicio de Neurología. Instituto Peruano de Neurociencias, Lima, Peru
| | - José Parodi
- Centro de Investigación del Envejecimiento, Facultad de Medicina Humana, Universidad San Martín de Porres, Lima, Peru
| | | | - Sheila Castro-Suarez
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru.,Servicio de Neurología. Instituto Peruano de Neurociencias, Lima, Peru.,Servicio de Neurología de la Conducta, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Rosa Montesinos
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru.,Servicio de Medicina Física y Rehabilitación, Clínica Internacional, Lima, Peru
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Schaller S, Mauskopf J, Kriza C, Wahlster P, Kolominsky-Rabas PL. The main cost drivers in dementia: a systematic review. Int J Geriatr Psychiatry 2015; 30:111-29. [PMID: 25320002 DOI: 10.1002/gps.4198] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 07/31/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Because of the increasing prevalence of dementia worldwide, combined with limited healthcare expenditures, a better understanding of the main cost drivers of dementia in different care settings is needed. METHODS A systematic review of cost-of-illness (COI) studies in dementia was conducted from 2003 to 2012, searching the following databases: PubMed (Medline), Cochrane Library, ScienceDirect (Embase) and National Health Service Economic Evaluations Database. Costs (per patient) by care setting were analyzed for total, direct, indirect and informal costs and related to the following: (1) cost perspective and (2) disease severity. RESULTS In total, 27 studies from 14 different healthcare systems were evaluated. In the included studies, total annual costs for dementia of up to $70,911 per patient (mixed setting) were estimated (average estimate of total costs = $30,554). The shares of cost categories in the total costs for dementia indicate significant differences for different care settings. Overall main cost drivers of dementia are informal costs due to home based long term care and nursing home expenditures rather than direct medical costs (inpatient and outpatient services, medication). CONCLUSIONS The results of this review highlight the significant economic burden of dementia for patients, families and healthcare systems and thus are important for future health policy planning. The significant variation of cost estimates for different care settings underlines the need to understand and address the financial burden of dementia from both perspectives. For health policy planning in dementia, future COI studies should follow a quality standard protocol with clearly defined cost components and separate estimates by care setting and disease severity.
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Affiliation(s)
- Sandra Schaller
- Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
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Abstract
Costs with dementia have been the focus of research around the world and indirect costs to the caregiver appear in the literature as responsible for the greatest impact. In Latin American (LA) studies, indirect costs with dementia range from 60% to 75% of family income. OBJECTIVE To present preliminary results of the study "Description of the methods and cost analysis with dementia" currently being conducted at the Behavioral and Cognitive Neurology Unit of Hospital de Clínicas of University of São Paulo - HC-FMUSP. METHODS A cross-sectional study which, to date, includes interviews of 93 primary caregivers. The research protocol includes a sociodemographic questionnaire, the Functional Assessment Staging (FAST) scale, the Burden Interview (Zarit), an economic classification scale, and the Resource Utilization in Dementia (RUD) scale. RESULTS Monthly indirect costs were US$ 1,122.40, US$ 1,508.90 and US$ 1,644.70 stratified into mild, moderate and severe dementia, respectively. The projected annual indirect costs were US$ 13,468.80, US$ 18,106.80 and US$ 19,736.40, representing 69 to 169% of family income. CONCLUSION This small sample showed that the impact of indirect costs with dementia in Brazil may be higher than that reported in other Latin American (LA) studies. These initial results may represent an important contribution for further research on costs with dementia in LA.
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Affiliation(s)
- Ceres Eloah Lucena Ferretti
- RN, PhD Behavioral and Cognitive Neurology Unit,
Department of Neurology, Hospital das Clínicas, University of São
Paulo, SP, Brazil
| | - Ricardo Nitrini
- MD, PhD Behavioral and Cognitive Neurology Unit,
Department of Neurology, Hospital das Clínicas, University of São
Paulo, SP, Brazil
| | - Sonia Maria Dozzi Brucki
- MD, PhD Behavioral and Cognitive Neurology Unit,
Department of Neurology, Hospital das Clínicas, University of São
Paulo, SP, Brazil
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Schwarzkopf L, Hao Y, Holle R, Graessel E. Health Care Service Utilization of Dementia Patients before and after Institutionalization: A Claims Data Analysis. Dement Geriatr Cogn Dis Extra 2014; 4:195-208. [PMID: 25337076 PMCID: PMC4187252 DOI: 10.1159/000362806] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Community-based and institutional dementia care has been compared in cross-sectional studies, but longitudinal information on the effect of institutionalization on health care service utilization is sparse. METHODS We analyzed claims data from 651 dementia patients via Generalized Estimation Equations to assess health care service utilization profiles and corresponding expenditures from four quarters before to four quarters after institutionalization. RESULTS In all domains, utilization increased in the quarter of institutionalization. Afterwards, the use of drugs, medical aids, and non-physician services (e.g., occupational therapy and physiotherapy) remained elevated, but use of in- and outpatient treatment decreased. Cost of care showed corresponding profiles. CONCLUSION Institutional dementia care seems to be associated with an increased demand for supportive services but not necessarily for specialized medical care.
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Affiliation(s)
- Larissa Schwarzkopf
- Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Neuherberg, Germany
| | - Yi Hao
- Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Neuherberg, Germany
| | - Rolf Holle
- Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Neuherberg, Germany
| | - Elmar Graessel
- Department of Medical Psychology and Medical Sociology, Alexander-Universität Erlangen-Nürnberg, Clinic for Psychiatry and Psychotherapy, Erlangen, Germany
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Chan ALF, Cham TM, Lin SJ. Direct medical costs in patients with Alzheimer's disease in Taiwan: A population-based study. Curr Ther Res Clin Exp 2014; 70:10-8. [PMID: 24692828 DOI: 10.1016/j.curtheres.2009.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2008] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Alzheimer's disease (AD) has the potential to become a major health concern and associated health care costs may become a significant economic burden on society. OBJECTIVE The aim of this study was to estimate the direct medical costs attributable to AD in patients aged ≥60 years in Taiwan from 2000 through 2002 and to explore the correlation of these costs with patients' age and sex. METHODS This study was based on the National Health Insurance Research Database of Taiwan's National Health Insurance (NHI) program. The NHI program insures >98% of the 23 million inhabitants of Taiwan. Detailed data were extracted from a random sample of 0.2% of inpatient and 5% of outpatient recipients with AD (International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code 331.0) who were aged ≥60 years and who received inpatient or outpatient services with claims from January 1, 2000, to December 31, 2002. Duplicate charges for a specific patient and diagnoses of other types of dementia were excluded from this study. RESULTS A total of 69,780 patients were found to have a diagnosis of AD. The direct medical costs for outpatients were estimated at US $1.2 million in 2000, US $1.9 million in 2001, and US $2.3 million in 2002; the costs for inpatient care were estimated at US $670,000 in 2000, US $2.4 million in 2001, and US $3.2 million in 2002. The total direct medical costs were estimated at US $1.86 million in 2000, US $4.24 million in 2001, and US $5.48 million in 2002. The increase of total direct medical costs was not significantly correlated with patients' age or sex. CONCLUSIONS From 2000 through 2002, the direct medical costs of AD increased annually in Taiwan among patients with AD aged ≥60 years. No significant correlation was found between increased total direct medical costs and sex or age. The cost estimate presented here has implications for future decision making about reallocating medical resources for treating AD in Taiwan.
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Affiliation(s)
- Agnes L F Chan
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan ; Chi Mei Medical Center, Tainan, Taiwan
| | - Thau-Ming Cham
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shun-Jin Lin
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
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König HH, Leicht H, Brettschneider C, Bachmann C, Bickel H, Fuchs A, Jessen F, Köhler M, Luppa M, Mösch E, Pentzek M, Werle J, Weyerer S, Wiese B, Scherer M, Maier W, Riedel-Heller SG. The Costs of Dementia From the Societal Perspective: Is Care Provided in the Community Really Cheaper than Nursing Home Care? J Am Med Dir Assoc 2014; 15:117-26. [DOI: 10.1016/j.jamda.2013.10.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 08/20/2013] [Accepted: 10/04/2013] [Indexed: 10/25/2022]
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Cieto BB, Valera GG, Soares GB, Cintra RHDS, Vale FAC. Dementia care in public health in Brazil and the world: A systematic review. Dement Neuropsychol 2014; 8:40-46. [PMID: 29213878 PMCID: PMC5619447 DOI: 10.1590/s1980-57642014dn81000007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 01/20/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE This study aimed to identify in the recent scientific literature, information on health care provided to people with dementia, dementia costs and its resource implications for public health. METHODS This was a systematic review of the literature in which the articles were consulted from the databases PubMed/MEDLINE, LILACS and SciELO. The review sample consisted of 45 articles. RESULTS Examination of the studies identified the current scenario of dementia in relation to public health and public policy in Brazil and the world. The analyzed studies revealed key information on aspects of dementia in the world. There was consensus on the high prevalence of the syndrome and on the significant cost of health care and public policy for assisting the elderly with dementia. CONCLUSION The importance of planning and implementing new public policies was recognized, since these are essential for the organization and management of health services and directly influence the country's ability to provide health care for people with dementia.
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Affiliation(s)
- Bianca Bolzan Cieto
- Nurse. Master's degree in Nursing by the Graduate Program
in Nursing at the Federal University of São Carlos - UFSCar. São
Carlos, São Paulo, Brazil
| | - Gabriela Gallego Valera
- Nurse. Master's degree in Nursing by the Graduate Program
in Nursing at the UFSCar. São Carlos, São Paulo, Brazil
| | - Glaucia Bueno Soares
- Nurse. Master's degree in Nursing by the Graduate Program
in Nursing at the UFSCar. São Carlos, São Paulo, Brazil
| | - Roberta Hehl de Sylos Cintra
- Lawyer, Biomedical. Master's degree in Ecology and
Natural Resources Graduate Program at the UFSCar. São Carlos, São
Paulo, Brazil
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Meng X, D'Arcy C. Mortality and morbidity hazards associated with cognitive status in seniors: a Canadian population prospective cohort study. Asia Pac Psychiatry 2013; 5:175-82. [PMID: 23857718 DOI: 10.1111/j.1758-5872.2012.00222.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 06/13/2012] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Although cognitive impairment is widely accepted as a leading indicator of dementia, influences of cognitive status on incident dementia and mortality remain unclear. The present study investigated the morbidity hazard associated with cognitive impairment and the mortality hazard associated with dementia in comparison to cognitively intact seniors. METHODS A population-based sample of 2914 seniors with clinically diagnosed cognitive status at Wave I (1991-1992) of the Canadian Study of Health and Aging (CSHA) were followed-up 5 years later (1996-1997). At Wave I, there were 921 cognitively intact, 861 cognitively impaired but not demented (CIND), and 1132 seniors with dementia, respectively. The primary outcome measures 5 years later were being cognitively intact, CIND, dementia and death. Kaplan-Meier estimates, log-rank tests, and Cox's proportional models were used in the analyses. RESULTS Respondents with CIND at Wave I were 2.191 times (95%CI 1.706-2.814) more likely to have dementia 5 years later than cognitively intact seniors. After adjusting for confounding socio-demographic and health status factors, the odds ratio was reduced to 2.147 times (95%CI 1.662-2.774), but remained significant. Respondents with CIND had a mortality rate 1.869 times (95%CI 1.602-2.179) and seniors with dementia 3.362 times greater (95%CI 2.929-3.860) than that of seniors who were cognitively intact. After controlling the confounders, the odds remained significant at 1.576 (95%CI 1.348-1.843) for CIND respondents and 2.415 (95%CI 2.083-2.800) for seniors with dementia. DISCUSSION CIND increases both the risk of dementia and mortality. Early intervention with CIND is warranted to reduce both dementia incidence and mortality.
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Affiliation(s)
- Xiangfei Meng
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Canada.
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Wimo A, Jönsson L, Bond J, Prince M, Winblad B. The worldwide economic impact of dementia 2010. Alzheimers Dement 2013; 9:1-11.e3. [PMID: 23305821 DOI: 10.1016/j.jalz.2012.11.006] [Citation(s) in RCA: 641] [Impact Index Per Article: 58.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 11/19/2012] [Accepted: 11/21/2012] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To acquire an understanding of the societal costs of dementia and how they affect families, health and social care services, and governments to improve the lives of people with dementia and their caregivers. METHODS The basic design of this study was a societal, prevalence-based, gross cost-of-illness study in which costs were aggregated to World Health Organization regions and World Bank income groupings. RESULTS The total estimated worldwide costs of dementia were US$604 billion in 2010. About 70% of the costs occurred in western Europe and North America. In such high-income regions, costs of informal care and the direct costs of social care contribute similar proportions of total costs, whereas the direct medical costs were much lower. In low- and middle-income countries, informal care accounts for the majority of total costs; direct social care costs are negligible. CONCLUSIONS Worldwide costs of dementia are enormous and distributed inequitably. There is considerable potential for cost increases in coming years as the diagnosis and treatment gap is reduced. There is also likely to be a trend in low- and middle-income countries for social care costs to shift from the informal to the formal sector, with important implications for future aggregated costs and the financing of long-term care. Only by investing now in research and the development of cost-effective approaches to early diagnosis and care can future societal costs be anticipated and managed.
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Affiliation(s)
- Anders Wimo
- KI-Alzheimer Disease Research Centre, Karolinska Institutet, Stockholm, Sweden.
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Abstract
The numbers and proportions of elderly are increasing rapidly in developing countries, where prevalence of dementia is often high. Providing cost-effective services for dementia sufferers and their caregivers in these resource-poor regions poses numerous challenges; developing resources for diagnosis must be the first step. Capacity building for diagnosis involves training and education of healthcare providers, as well as the general public, development of infrastructure, and resolution of economic and ethical issues. Recent progress in some low-to-middle-income countries (LMICs) provides evidence that partnerships between wealthy and resource-poor countries, and between developing countries, can improve diagnostic capabilities. Without the involvement of the mental health community of developed countries in such capacity-building programs, dementia in the developing world is a disaster waiting to happen.
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Affiliation(s)
- Gladys E Maestre
- Laboratory of Neurosciences, University of Zulia, Edificio del Instituto de Enfermedades Cardiovasculares de la Universidad del Zulia, Primer Piso, Av Universidad diagonal al MACZUL, Maracaibo, 4002 Zulia, Venezuela.
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Sakurai T, Kitadate K, Nishioka H, Fujii H, Ogasawara J, Kizaki T, Sato S, Fujiwara T, Akagawa K, Izawa T, Ohno H. Oligomerised lychee fruit-derived polyphenol attenuates cognitive impairment in senescence-accelerated mice and endoplasmic reticulum stress in neuronal cells. Br J Nutr 2013; 110:1549-58. [DOI: 10.1017/s000711451300086x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Recently, the ability of polyphenols to reduce the risk of dementia and Alzheimer's disease (AD) has attracted a great deal of interest. In the present study, we investigated the attenuating effects of oligomerised lychee fruit-derived polyphenol (OLFP, also called Oligonol) on early cognitive impairment. Male senescence-accelerated mouse prone 8 (SAMP8) mice (4 months old) were given OLFP (100 mg/kg per d) for 2 months, and then conditioned fear memory testing was conducted. Contextual fear memory, which is considered hippocampus-dependent memory, was significantly impaired in SAMP8 mice compared with non-senescence-accelerated mice. OLFP attenuated cognitive impairment in SAMP8 mice. Moreover, the results of real-time PCR analysis that followed DNA array analysis in the hippocampus revealed that, compared with SAMP8 mice, the mRNA expression of Wolfram syndrome 1 (Wfs1) was significantly higher in SAMP8 mice administered with OLFP. Wfs1 reportedly helps to protect against endoplasmic reticulum (ER) stress, which is thought to be one of the causes for AD. The expression of Wfs1 was significantly up-regulated in NG108-15 neuronal cells by the treatment with OLFP, and the up-regulation was inhibited by the treatment of the cells with a c-Jun N-terminal kinase-specific inhibitor rather than with an extracellular signal-regulated kinase inhibitor. Moreover, OLFP significantly attenuated the tunicamycin-induced expression of the ER stress marker BiP (immunoglobulin heavy chain-binding protein) in the cells. These results suggest that OLFP has an attenuating effect on early cognitive impairment in SAMP8 mice, and diminishes ER stress in neuronal cells.
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Costa N, Ferlicoq L, Derumeaux-Burel H, Rapp T, Garnault V, Gillette-Guyonnet S, Andrieu S, Vellas B, Lamure M, Grand A, Molinier L. Comparison of informal care time and costs in different age-related dementias: a review. Biomed Res Int 2012; 2013:852368. [PMID: 23509789 PMCID: PMC3591240 DOI: 10.1155/2013/852368] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 10/25/2012] [Accepted: 10/25/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Age-related dementia is a progressive degenerative brain syndrome whose prevalence increases with age. Dementias cause a substantial burden on society and on families who provide informal care. This study aims to review the relevant papers to compare informal care time and costs in different dementias. METHODS A bibliographic search was performed on an international medical literature database (MEDLINE). All studies which assessed the social economic burden of different dementias were selected. Informal care time and costs were analyzed in three care settings by disease stages. RESULTS 21 studies met our criteria. Mean informal care time was 55.73 h per week for Alzheimer disease and 15.8 h per week for Parkinson disease (P = 0.0076), and the associated mean annual informal costs were $17,492 versus $3,284, respectively (P = 0.0393). CONCLUSION There is a lack of data about informal care time and costs among other dementias than AD or PD. Globally, AD is the most costly in terms of informal care costs than PD, $17,492 versus $3,284, respectively.
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Costa N, Derumeaux H, Rapp T, Garnault V, Ferlicoq L, Gillette S, Andrieu S, Vellas B, Lamure M, Grand A, Molinier L. Methodological considerations in cost of illness studies on Alzheimer disease. Health Econ Rev 2012; 2:18. [PMID: 22963680 PMCID: PMC3563616 DOI: 10.1186/2191-1991-2-18] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 08/27/2012] [Indexed: 05/18/2023]
Abstract
Cost-of-illness studies (COI) can identify and measure all the costs of a particular disease, including the direct, indirect and intangible dimensions. They are intended to provide estimates about the economic impact of costly disease. Alzheimer disease (AD) is a relevant example to review cost of illness studies because of its costliness.The aim of this study was to review relevant published cost studies of AD to analyze the method used and to identify which dimension had to be improved from a methodological perspective. First, we described the key points of cost study methodology. Secondly, cost studies relating to AD were systematically reviewed, focussing on an analysis of the different methods used. The methodological choices of the studies were analysed using an analytical grid which contains the main methodological items of COI studies. Seventeen articles were retained. Depending on the studies, annual total costs per patient vary from $2,935 to $52, 954. The methods, data sources, and estimated cost categories in each study varied widely. The review showed that cost studies adopted different approaches to estimate costs of AD, reflecting a lack of consensus on the methodology of cost studies. To increase its credibility, closer agreement among researchers on the methodological principles of cost studies would be desirable.
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Affiliation(s)
- Nagede Costa
- Department of Medical Information, University Hospital of Toulouse, Toulouse, F-31059, France
- UMR 1027, INSERM, Toulouse, F-31059, France
| | - Helene Derumeaux
- Department of Medical Information, University Hospital of Toulouse, Toulouse, F-31059, France
| | - Thomas Rapp
- Universty of Paris Descartes, Paris, 75016, France
| | - Valérie Garnault
- Department of Medical Information, University Hospital of Toulouse, Toulouse, F-31059, France
| | - Laura Ferlicoq
- Department of Medical Information, University Hospital of Toulouse, Toulouse, F-31059, France
| | - Sophie Gillette
- UMR 1027, INSERM, Toulouse, F-31059, France
- UMR 1027, University of Toulouse III, Toulouse, F-31059, France
- Universty of Paris Descartes, Paris, 75016, France
| | - Sandrine Andrieu
- UMR 1027, INSERM, Toulouse, F-31059, France
- UMR 1027, University of Toulouse III, Toulouse, F-31059, France
- Department of Epidemiology and Public Health, University Hospital of Toulouse, Toulouse, F-31059, France
| | - Bruno Vellas
- UMR 1027, INSERM, Toulouse, F-31059, France
- UMR 1027, University of Toulouse III, Toulouse, F-31059, France
- Department of geriatric medicine, University hospital of Toulouse, Toulouse, F-31073, France
| | - Michel Lamure
- EDISS, University of Lyon I, Villeurbanne, F-69100, France
| | - Alain Grand
- UMR 1027, INSERM, Toulouse, F-31059, France
- UMR 1027, University of Toulouse III, Toulouse, F-31059, France
- Department of Epidemiology and Public Health, University Hospital of Toulouse, Toulouse, F-31059, France
| | - Laurent Molinier
- Department of Medical Information, University Hospital of Toulouse, Toulouse, F-31059, France
- UMR 1027, INSERM, Toulouse, F-31059, France
- UMR 1027, University of Toulouse III, Toulouse, F-31059, France
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Allegri RF, Russo MJ. News in aging and dementia at the 13th Pan American Congress of Neurology. Expert Rev Neurother 2012; 12:777-9. [PMID: 22853785 DOI: 10.1586/ern.12.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Pan American Congress of Neurology was organized by the Bolivian Society of Neurology on behalf of the World Federation of Neurology in La Paz, Bolivia. Aging and dementia was one of the main congress tracks that has been highlighted in recent Latin American research in the field, focusing specifically on epidemiological studies, the economic cost of dementia and new Alzheimer's disease (AD) biomarkers. A 4-year follow-up study of AD biomarkers was discussed and a survey was conducted in Argentina on the opinion of the general population in relation to the clinical use of these biomarkers, and early diagnosis criteria of AD were presented. In parallel, a newly developed Neurology International Conference for Primary Care was run that was designed for the education of more than 350 general practitioners from all the regions of Bolivia.
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Affiliation(s)
- Ricardo F Allegri
- Department of Cognitive Neurology, Instituto de Investigaciones Neurológicas, Buenos Aires, Argentina.
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Sakurai T, Ogasawara J, Kizaki T, Ishibashi Y, Fujiwara T, Akagawa K, Izawa T, Oh-ishi S, Haga S, Ohno H. Involvement of leucine zipper transcription factor-like protein 1 (Lztfl1) in the attenuation of cognitive impairment by exercise training. Biochem Biophys Res Commun 2011; 416:125-9. [PMID: 22093827 DOI: 10.1016/j.bbrc.2011.11.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 11/01/2011] [Indexed: 12/01/2022]
Abstract
It is well known that exercise prevents and reduces cognitive impairment. In the present study, we focused on exercise training as a tool to prevent cognitive impairment, and searched for novel molecules that may relate to the prevention of cognitive impairment in the hippocampus. Two-month-old senescence-accelerated mouse prone-8 (SAMP8) mice were subjected to voluntary exercise training by running on a wheel for 4 months, and were then assigned a conditioned fear memory test. Moreover, various mRNA levels in the hippocampus were examined by DNA array analysis and real-time PCR. Contextual fear memory in SAMP8 control mice was significantly impaired compared with that in non-senescence mice. Exercise training definitely attenuated such cognitive impairment. The results of real-time PCR analysis that was conducted following DNA array analysis in the hippocampus revealed that, compared with SAMR8 control mice, the expression levels of leucine zipper transcription factor-like protein 1 (Lztfl1) mRNA were significantly higher in SAMP8 mice subjected to exercise training. In addition, the overexpression of Lztfl1 promoted neurite outgrowth in Neuro 2a cells. These results suggest that exercise has a preventive effect on cognitive impairment in SAMP8 mice, and that exercise-induced increase in Lztfl1 induces neurite outgrowth.
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Affiliation(s)
- Takuya Sakurai
- Department of Molecular Predictive Medicine and Sport Science, Kyorin University, School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan.
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Salvia MG, Dawidowski A, Schapira M, Figar S, Söderlund ME, Seinhart D, Cámera L, Teri L. Spanish Revised Memory and Behavior Problems Checklist Scale (SpRMBPC): trans-cultural adaptation and validation of the RMBPC questionnaire. Int Psychogeriatr 2011; 23:1160-6. [PMID: 21294937 DOI: 10.1017/S1041610210002073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The use of standardized scales is critical for monitoring the interventions within and between different populations, but the current Spanish tools are dispersed in several scales. A simple tool for simultaneously and exhaustively evaluating patient's symptoms and caregiver's distress in Spanish-speaking groups is needed. METHODS RMBPC was translated into Spanish by cross-cultural adaptation. Comprehensibility and easiness of SpRMBPC were evaluated with 92 patient-caregiver dyads. Reliability, stability and scale structure were evaluated by Cronbach's α, test-retest and factor analysis respectively. Concurrent and discriminant validity were assessed by correlation with validated tools for measuring stage of dementia; memory, disruptive behaviors and depression symptoms of the patients; and anxiety, depression and burden of the caregivers (CDR, MMSE, NPIq, NPI disruption, NPI depression, HADS-A; HADS-D and Zarit Burden Interview respectively). RESULTS Almost all caregivers completed the questionnaire (97% completeness; 7.5% missing data). Both the frequency of Patient's Symptoms and Caregiver Reaction scores and subscores displayed high stability and reliability. All of these scores correlated positively with their respective validated tools as predicted, except with MMSE. The patients' subscores for Disruptive Behaviors and Memory Impairment displayed their highest correlation with the disruptive symptoms and level of dementia validated tools. CONCLUSIONS SpRMBPC is a validated tool for assessing the dementia stage and the psychiatric morbidity of patients and caregivers. The Frequency Disruption and Memory subscales assess specifically patient's disruptive symptoms and dementia stages. These tools can be applied to analyze the burden of the patient's disease and the caregiver's distress in Spanish-speaking populations.
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Machnicki G, Dillon C, Allegri RF. Insurance status and demographic and clinical factors associated with pharmacologic treatment of depression: associations in a cohort in Buenos Aires. Value Health 2011; 14:S13-S15. [PMID: 21839885 DOI: 10.1016/j.jval.2011.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE There is a paucity of evidence about insurance status and the likelihood of receiving medical services in Latin America. The objective of this analysis was to examine the association between insurance status and pharmacologic treatment for depression. METHODS Patients referred to a memory clinic of a public hospital in Buenos Aires, Argentina, and identified with any of four types of depression (subsyndromal, dysthymia, major, and due to dementia) were included. Age, years of education, insurance status, Beck Depression Inventory score, and number of comorbidities were considered. Associations between these factors and not receiving pharmacologic treatment for depression were examined with logistic regression. Use of prescription neuroleptics, hypnotics, and anticholinesterase inhibitors was also explored. RESULTS Out of 100 patients, 92 with insurance status data were used. Sixty-one patients (66%) had formal insurance and 31 patients (34%) lacked insurance. Twenty-seven (44%) insured patients and 23 (74%) uninsured patients did not receive antidepressants (P = 0.001). Controlling for other factors, uninsured patients had 7.12 higher odds of not receiving treatment compared to insured patients (95% confidence interval 1.88-28.86). Older patients and those with more comorbidities had higher odds of not receiving treatment. More educated patients, those with higher Beck Depression Inventory score, and those without subsyndromal depression had lower odds of not receiving treatment. None of those associations were statistically significant. CONCLUSIONS These results suggest a potential negative effect of the lack of formal insurance regarding pharmacologic treatment for depression. These findings should be confirmed with larger samples, and for other diseases.
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Affiliation(s)
- Gerardo Machnicki
- Memory Research Center, Department of Neurology, Zubizarreta General Hospital, GCBA Buenos Aires, Argentina
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Rojas G, Bartoloni L, Dillon C, Serrano CM, Iturry M, Allegri RF. Clinical and economic characteristics associated with direct costs of Alzheimer's, frontotemporal and vascular dementia in Argentina. Int Psychogeriatr 2011; 23:554-61. [PMID: 21044400 DOI: 10.1017/S1041610210002012] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The economic cost of dementia is high and can be predicted by cognitive and neuropsychiatric profiles. The differential costs of the various subtypes of dementia are unknown in Argentina, and this study therefore aimed to compare these costs. METHODS Patients with a diagnosis of dementia of Alzheimer-type (DAT), frontotemporal dementia (FTD) and vascular dementia (VaD), and their primary caregivers, were evaluated between 2002 and 2008. RESULTS 104 patients with dementia (DAT = 44, FTD = 34, VaD = 26) were screened and matched by age and educational level with 29 healthy subjects. Demographic variables showed no significant differences among dementia patients. The annual direct costs were US$4625 for DAT, US$4924 for FTD, and US$5112 for VaD (p > 0.05 between groups). In the post hoc analysis VaD showed higher hospitalization costs than DAT (p < 0.001). VaD exhibited lower medication costs than FTD (p < 0.001). DAT exhibited higher anti-dementia drug costs; FTD had higher psychotropic costs. In the multivariate analysis, depression, activities of daily living, and caregiver burden were correlated with direct costs (r2 = 0.76). CONCLUSIONS The different dementia types have different costs. Overall, costs increased with the presence of behavioral symptoms, depression and functional impairment of activities of daily living.
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Allegri RF, Arizaga RL, Bavec CV, Colli LP, Demey I, Fernández MC, Frontera SA, Garau ML, Jiménez JJ, Golimstok Á, Kremer J, Labos E, Mangone CA, Ollari JA, Rojas G, Salmini O, Ure JA, Zuin DR. Enfermedad de Alzheimer. Guía de práctica clínica. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/s1853-0028(11)70026-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Abstract
Alzheimer’s disease (AD) patients suffer progressive cognitive, behavioral and
functional impairment which result in a heavy burden to patients, families, and
the public-health system. AD entails both direct and indirect costs. Indirect
costs (such as loss or reduction of income by the patient or family members) are
the most important costs in early and community-dwelling AD patients. Direct
costs (such as medical treatment or social services) increase when the disorder
progresses, and the patient is institutionalized or a formal caregiver is
required. Drug therapies represent an increase in direct cost but can reduce
some other direct or indirect costs involved. Several studies have projected
overall savings to society when using drug therapies and all relevant cost are
considered, where results depend on specific patient and care setting
characteristics. Dementia should be the focus of analysis when public health
policies are being devised. South American countries should strengthen their
policy and planning capabilities by gathering more local evidence about the
burden of AD and how it can be shaped by treatment options.
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Affiliation(s)
- Diego M Castro
- MD, Servicios de Neuropsicología (SIREN) y Neurología, Instituto Universitario CEMIC, Buenos Aires, Argentina
| | - Carol Dillon
- MD, Laboratorio de Memoria, Servicio de Neurología, Hospital General Abel Zubizarreta, Buenos Aires, Argentina
| | - Gerardo Machnicki
- MSc, Laboratorio de Memoria, Servicio de Neurología, Hospital General Abel Zubizarreta, Buenos Aires, Argentina
| | - Ricardo F Allegri
- MD and PhD, Servicios de Neuropsicología (SIREN) y Neurología, Instituto Universitario CEMIC, y Laboratorio de Memoria, Servicio de Neurología, Hospital General Abel Zubizarreta, Buenos Aires, Argentina
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Abstract
Alzheimer's disease is associated with a substantial economic impact on patients, their caregivers and society. Due to the current rise in the aging population, the prevalence and impact of Alzheimer's disease are expected to increase greatly. The cost of caring for someone with Alzheimer's disease is magnified in the more severe stages of the disease. There are four cognitive enhancers commonly used for the treatment of Alzheimer's disease: three cholinesterase inhibitors (donepezil, rivastigmine and galantamine) and one NMDA receptor antagonist (memantine). Of these, donepezil and memantine have been approved in many countries as pharmacological treatments for moderate to severe Alzheimer's disease, while donepezil, rivastigmine and galantamine are approved treatments for mild to moderate Alzheimer's disease. While cost effectiveness has been well studied in mild to moderate Alzheimer's disease, the cost-benefit information for drug therapy in moderate to severe Alzheimer's disease is less clear. This article reviews the pharmacoeconomic data available on these four drugs, with a specific focus on moderate to severe Alzheimer's disease, including economic burden, cost drivers, clinical outcomes and pharmacoeconomic studies. A key driver of the cost of Alzheimer's disease is the severity of the disease, indicating that the ability to stabilize the disease state is a potential source of cost savings. Drug therapies that can limit increases in behavioural problems and cognitive and functional impairment, and postpone institutionalization without an increase in longevity may serve to reduce the economic burden on Alzheimer's disease patients. The data suggest that, while the available, approved agents offer only modest improvements in clinical outcomes, they could be cost-effective treatments for moderate to severe Alzheimer's disease when viewed from the societal perspective. For memantine and donepezil, data are available that suggest that the cost of these drugs is offset by the clinical and societal benefits provided by slowing the progression of Alzheimer's disease. While there are few head-to-head comparison trials, the similarity in costs of the treatments and efficacy against placebo suggest that cost effectiveness will not be substantially different among treatments. More studies that examine longitudinal resource utilization and its relationship to drug treatment in the moderate to severe stages are needed to clarify cost benefit in this population and possibly differentiate between individual medications.
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Affiliation(s)
- Jaclyn Cappell
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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