Direct Medical Costs of Dementia With Lewy Bodies by Disease Complexity

Espinosa, Robert; Davis, Matthew; Johnson, Scott W.; Cline, Stephanie; Weintraub, Daniel

doi:10.1016/j.jamda.2020.06.006

Cited by 9 publications

(8 citation statements)

References 35 publications

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“…These overt clinically manifest fluctuations are typically recognized by clinical interview with a carer/informant who may report varying levels of confusion or consciousness over the course of minutes, hours, or days (Lee et al, 2014; Walker et al, 2000). Cognitive fluctuations are crucial to recognize and understand, being associated with worse prognosis in MCI (Hamilton et al, 2021a) and greater healthcare utilization costs in dementia (Espinosa et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

Sustained attention in mild cognitive impairment with Lewy bodies and Alzheimer’s disease

Hamilton,

Gallagher,

Ciafone

et al. 2023

J Int Neuropsychol Soc

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Objective: Attentional impairments are common in dementia with Lewy bodies and its prodromal stage of mild cognitive impairment (MCI) with Lewy bodies (MCI-LB). People with MCI may be capable of compensating for subtle attentional deficits in most circumstances, and so these may present as occasional lapses of attention. We aimed to assess the utility of a continuous performance task (CPT), which requires sustained attention for several minutes, for measuring attentional performance in MCI-LB in comparison to Alzheimer’s disease (MCI-AD), and any performance deficits which emerged with sustained effort. Method: We included longitudinal data on a CPT sustained attention task for 89 participants with MCI-LB or MCI-AD and 31 healthy controls, estimating ex-Gaussian response time parameters, omission and commission errors. Performance trajectories were estimated both cross-sectionally (intra-task progress from start to end) and longitudinally (change in performance over years). Results: While response times in successful trials were broadly similar, with slight slowing associated with clinical parkinsonism, those with MCI-LB made considerably more errors. Omission errors were more common throughout the task in MCI-LB than MCI-AD (OR 2.3, 95% CI: 1.1–4.7), while commission errors became more common after several minutes of sustained attention. Within MCI-LB, omission errors were more common in those with clinical parkinsonism (OR 1.9, 95% CI: 1.3–2.9) or cognitive fluctuations (OR 4.3, 95% CI: 2.2–8.8). Conclusions: Sustained attention deficits in MCI-LB may emerge in the form of attentional lapses leading to omissions, and a breakdown in inhibitory control leading to commission errors.

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Section: Introductionmentioning

confidence: 99%

Sustained attention in mild cognitive impairment with Lewy bodies and Alzheimer’s disease

Hamilton,

Gallagher,

Ciafone

et al. 2023

J Int Neuropsychol Soc

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“…Clinical care in individuals with LBD is challenging due to complex motor, cognitive, behavioral, and autonomic symptoms. LBD is associated with poorer prognosis in mortality and nursing home placement, significant impact on patient quality of life, and higher caregiver burden and healthcare costs, compared to individuals with AD dementia [4]. Despite this, there is a critical lack of symptomatic and disease-modifying therapy in LBD.…”

Section: Introductionmentioning

confidence: 99%

Lewy Body Dementias: Controversies and Drug Development

2022

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Lewy body dementia (LBD) is one of the most common neurodegenerative dementias. Clinical trials for symptomatic and disease-modifying therapies in LBD remain a national research priority, but there are many challenges in both past and active drug developments in LBD. This review highlights the controversies in picking the appropriate populations, interventions, target selections, and outcome measures, which are all critical components of clinical trial implementation in LBD. The heterogeneity of LBD neuropathology and clinical presentations, limited understanding of core features such as cognitive fluctuations, and lack of validated LBD-specific outcome measures and biomarkers represent some of the major challenges in LBD trials. KeywordsLewy body dementia [MeSH term] • Dementia with Lewy bodies • Parkinson disease dementia • Drug therapy [MeSH term] • Treatment • Clinical trial as topic [MeSH term]

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“…LBD encompasses dementia with Lewy bodies (DLB) and PD dementia (PDD) [ 5 ], and as a result of its progressive nature, the disease is associated with a substantial clinical burden. People with LBD experience lower quality of life [ 6 ], higher and earlier mortality [ 7 , 8 ], higher hospitalization rates [ 9 ], and greater variability in cognitive decline relative to patients with Alzheimer’s disease (AD) [ 10 ], as well as high healthcare resource utilization and costs [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Disease Progression and Longitudinal Clinical Outcomes of Lewy Body Dementia in the NACC Database

et al. 2022

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Introduction: As the identification of Lewy body dementia (LBD) is often confirmed postmortem, there is a paucity of evidence on the progression of disease antemortem. This study aimed to comprehensively assess the course of LBD over time across cognitive, functional, and neuropsychiatric outcomes using real-world data. Methods: Adults with at least one visit to an Alzheimer's Disease Center with a diagnosis of mild cognitive impairment/dementia (index date), indication of LBD, and at least one follow-up visit were identified in the National Alzheimer's Coordinating Center database (September 2005-June 2020). Participant characteristics, medication use, comorbidities, and changes in outcomes were assessed over a 5-year follow-up period and stratified by disease severity based on the Clinical Dementia Rating (CDRÒ) Dementia Staging Instrument-Sum of Boxes (CDR-SB) score at index. Results: A total of 2052 participants with LBD (mean age at index 73.4 years) were included (mild, 219; moderate, 988; severe, 845). Mean annualized increase over 5 years was 0.9 points for CDR-Global Score, 5.6 points for CDR-SB, 10.4 points for the Functional Activities Questionnaire, and 2.0 points for the Neuropsychiatric Inventory-Questionnaire. Disease progression was greater among participants with moderate and severe LBD at index compared with those with mild LBD. Conclusion: Participants with LBD experienced decline across all outcomes over time, and impairment increased with disease severity. Findings highlight the substantial clinical burden associated with LBD and the importance of earlier diagnosis and effective treatment. Further research is needed to understand the predictors of cognitive and functional decline in LBD which may help inform clinical trials.

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Direct Medical Costs of Dementia With Lewy Bodies by Disease Complexity

Cited by 9 publications

References 35 publications

Sustained attention in mild cognitive impairment with Lewy bodies and Alzheimer’s disease

Sustained attention in mild cognitive impairment with Lewy bodies and Alzheimer’s disease

Lewy Body Dementias: Controversies and Drug Development

Disease Progression and Longitudinal Clinical Outcomes of Lewy Body Dementia in the NACC Database

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