Recommendations for best practices in the treatment of Alzheimer's disease in managed care

Prospective One-Year Cost-of-Illness Study in a Cohort of Patients with Dementia of Alzheimer's Disease Type in Spain: The ECO Study

“…The unit of measurement used has been the daily dose, given that it is better understood from a clinical point of view and because in order to compare this variable to the dependent variable (over a one month period), one can simply multiply the dose by a constant (30 days) without changing the modeling results. In addition, the univariate General Linear Model has also been used to relate the average monthly cost to the variables related to institutionalizing the patient and to attendance at day centers, the severity of AD and the patient's state of health, as well as the level of predictive value provided by the caregiver's general state of health and the caregiver's burden [39][40][41][42]. The level of severity of the patient's AD has been represented using CDR, MMSE, and BDRS scores [24][25][26][27].…”

Should older adults be screened for dementia? It is important to screen for evidence of dementia!

“…Analyses of this issue should formally address the "cost-worthiness" of the medical test [25]). Such analyses have been reported and published [11], and looking at limited health economic data, the results tend to support screening. However, the A&D Consensus Group further argued that the benefits from having information about mental dysfunction can help the patient's support system function more efficiently and with less stress and plan for more effective management of the issues that will develop as the patient deteriorates.…”

“…Given the abundance of adequate tests for recognizing mild dementia, the numerous benefits in doing so, the slight costs associated with such testing, and the minimal nature of the potential harms from such investigation (Table 1), this group recommended the consideration of implementation of procedures to screen for dementia. The perspective that it is reasonable to recommend screening for dementia has only recently developed and has been championed independently by other groups [10][11][12].…”

“…The NICE appraisal was revised in November 2006 to include a recommendation for subsidizing use of cholinesterase inhibitors for moderately demented patients with Alzheimer's disease [21]. However, the preponderance of the studies have shown that the approved dementia medications have useful benefit for many patients [11,22,23]. Beyond specific treatments for Alzheimer's disease, there are efficacious biologic, psychological, and social interventions that should be at least considered as soon as possible in the Alzheimer's disease course and the types of dementia associated with other etiologies.…”

“…As noted earlier, there has been some debate about this point, but many studies have shown the benefits of the treatments on biologic (brain scans), psychological (cognitive testing and behavioral testing), and social (ADLs, activities of daily living) measurements [11,22]. Furthermore, there are many types of dementia beyond Alzheimer's disease in which a specific early intervention is clinically superior to no intervention.…”