Functional Impairment, Healthcare Costs and the Prevalence of Institutionalisation in Patients with Alzheimer??s Disease and Other Dementias

Hill, Jerrold; Fillit, Howard; Thomas, Simu K.; Chang, Sangmi

doi:10.2165/00019053-200624030-00006

Cited by 77 publications

(57 citation statements)

References 23 publications

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“…One study estimates that, for every additional ADL dependency, there is an increase of $1,958 (1998 dollars) in healthcare costs per year. 12 In addition, bladder anticholinergics and ChIs are costly and only modestly effective. [34][35][36] The combined monthly consumer cost for a ChI and oxybutynin or tolterodine is approximately $200.…”

Section: Discussionmentioning

confidence: 99%

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Dual Use of Bladder Anticholinergics and Cholinesterase Inhibitors: Long‐Term Functional and Cognitive Outcomes

Sink

Thomas

et al. 2008

J American Geriatrics Society

142

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OBJECTIVES-To determine the cognitive and functional consequences of dual use of cholinesterase inhibitors (ChIs) and the bladder anticholinergics oxybutynin or tolterodine. DESIGN-Prospective cohort study.SETTING-Nursing homes (NHs) in the state of Indiana.PARTICIPANTS-Three thousand five hundred thirty-six Medicaid-eligible NH residents aged 65 and older taking a ChI between January 1, 2003, and December 31, 2004. Residents were excluded if they were taking an anticholinergic other than oxybutynin or tolterodine. MEASUREMENTS-IndianaMedicaid claims data were merged with data from the Minimum Data Set (MDS). Repeated-measures analyses were performed to assess the effects of dual therapy on change in cognitive function measured using the MDS Cognition Scale (MDS-COGS; scored 0-10) and change in activity of daily living (ADL) function using the seven ADL items in the MDS (scored 0-28). Potential covariates included age, sex, race, number of medications, and Charlson Comorbidity Index score.RESULTS-Three hundred seventy-six (10.6%) residents were prescribed oxybutynin or tolterodine concomitantly with a ChI. In residents in the top quartile of ADL function, ADL function declined an average of 1.08 points per quarter when not taking bladder anticholinergics (ChI alone), compared with 1.62 points per quarter when taking dual therapy, a 50% greater rate in Address correspondence to Kaycee M. Sink, MD, MAS, Assistant Professor of Medicine, Sticht Center on Aging, Wake Forest University, Medical Center Blvd, Winston-Salem, NC 27157. kmsink@wfubmc.edu. This research was presented in part at the 2006 Annual Meeting of the American Geriatrics Society. Conflict of Interest:The editor in chief has reviewed the conflict of interest checklist provided by the author and has determined that none of the authors have any financial or any other kind of personal conflicts with this manuscript.Author Contribution: All authors contributed to the study concept and design, analysis and interpretation of the data, and preparation of the manuscript. Drs. Sands and Thomas acquired the data. HHS Public Access Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript quarterly decline in ADL function (P =.01). There was no excess decline attributable to dual therapy in MDS-COGS scores or in ADL function for residents who started out with lower functioning.CONCLUSION-In higher-functioning NH residents, dual use of ChIs and bladder anticholinergics may result in greater rates of functional decline than use of ChIs alone. The MDS-COGS may not be sensitive enough to detect differences in cognition due to dual use. Keywordsdementia; incontinence; pharmacotherapy; anticholinergics; cholinesterase inhibitorsOlder adults, particularly those in nursing homes (NHs), are likely to have multiple medical conditions requiring complex medical management that can lead to therapeutic dilemmas. For example, two of the most common medical conditions in NH residents are dementia and urinary incontinence (UI), and they often coexist. 1,2 Ch...

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Section: Discussionmentioning

confidence: 99%

“…Loss of functioning in persons with dementia is costly to consumers and the government. 12 Information is needed regarding prescribing practices that may accelerate rates of cognitive and functional decline in persons with dementia.…”

mentioning

confidence: 99%

Dual Use of Bladder Anticholinergics and Cholinesterase Inhibitors: Long‐Term Functional and Cognitive Outcomes

Sink

Thomas

et al. 2008

J American Geriatrics Society

142

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“…Uma das escalas mais utilizadas para avaliar o desempenho nas atividades da vida diária é a Escala de Independência em Atividades da Vida Diária (EIAVD), ou Escala de Katz 4,5,6,7,8,9,10,11 . Ela foi desenvolvida para a avaliação dos resultados de tratamentos em idosos e predizer o prognóstico nos doentes crônicos.…”

Section: This Study Involved the Development And Performance Assessmeunclassified

Adaptação transcultural da Escala de Independência em Atividades da Vida Diária (Escala de Katz)

et al. 2008

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This study involved the development and performance assessment of a cultural adaptation of the Katz scale of independence in activities of daily living, translated into Portuguese in BrazilA capacidade funcional é medida por meio de instrumentos padronizados que avaliam o desempenho do idoso nas atividades da vida diária e nas atividades instrumentais da vida diá-ria. Uma das escalas mais utilizadas para avaliar o desempenho nas atividades da vida diária é a Escala de Independência em Atividades da Vida Diária (EIAVD), ou Escala de Katz 4,5,6,7,8,9,10,11 . Ela foi desenvolvida para a avaliação dos resultados de tratamentos em idosos e predizer o prognóstico nos doentes crônicos. A EIAVD consta de seis itens que medem o desempenho do indivíduo nas atividades de autocuidado, os quais obedecem a uma hierarquia de complexidade, da seguinte forma: alimentação, controle de esfíncteres, transferência, higiene pessoal, capacidade para se vestir e tomar banho 4 . Essa seqüência é semelhante à observada durante o desenvolvimento infantil, em que primeiramente a criança aprende a levar a colher à boca para, somente mais tarde, tornar-se capaz de tomar banho de forma independente. Tais considerações levaram à suposição de que a escala ARTIGO ARTICLE

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“…This then leads to increased rates of institutionalization and health care costs. A strong relationship has been demonstrated between functional impairment and health care costs in patients with dementia (Hill et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

Executive functioning in Alzheimer's disease and vascular dementia

Barrett

Craig

Lawson

et al. 2009

Int J Geriat Psychiatry

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This is an original work which has not been published elsewhere or submitted for publication elsewhere. A paper on attention deficits in the same cohort of patients has been accepted to JNNP and is currently in print (McGuinness et al.). There is however no overlap between the neuropsychological tests used and it has been referenced in the discussion.Objective: To compare performance of patients with mild-moderate Alzheimer's disease (AD) and vascular dementia (VaD) on tests of executive functioning and working memory. Methods: Patients with AD (n ¼ 76) and VaD (n ¼ 46) were recruited from a memory clinic along with dementia free participants (n ¼ 28). They underwent specific tests of working memory from the Cognitive Drug Research (CDR) battery and pen and paper tests of executive function including CLOX 1 & 2, EXIT25 and a test of verbal fluency (COWAT). All patients had a CT brain scan which was independently scored for white matter change/ischaemia. Results: The AD and VaD groups were significantly impaired on all measures of working memory and executive functioning compared to the disease free group. There were no significant differences between the AD and VaD groups on any measure. Z-scores confirmed the pattern of impairment in executive functioning and working memory was largely equivalent in both patient groups. Small to moderate correlations were seen between the MMSE and the neurocognitive scores in both patient groups and the pattern of correlations was also very similar in both patient groups. Conclusions: This study demonstrates sizeable executive functioning and working memory impairments in patients with mild-moderate AD and VaD but no significant differences between the disease groups.

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Functional Impairment, Healthcare Costs and the Prevalence of Institutionalisation in Patients with Alzheimer??s Disease and Other Dementias

Cited by 77 publications

References 23 publications

Dual Use of Bladder Anticholinergics and Cholinesterase Inhibitors: Long‐Term Functional and Cognitive Outcomes

Dual Use of Bladder Anticholinergics and Cholinesterase Inhibitors: Long‐Term Functional and Cognitive Outcomes

Adaptação transcultural da Escala de Independência em Atividades da Vida Diária (Escala de Katz)

Executive functioning in Alzheimer's disease and vascular dementia

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