3 new dementia studies of note
James E. Galvin, M.D., M.P.H.
New research quantifies costs associated with dementia care compared with other diseases and offers a little good news for those with Lewy body dementia or Alzheimer's disease.
High costs of dementia care
The cost of care over the last five years of life for people who have dementia is significantly higher than for people who die from heart disease, cancer or other causes, according to a study led by researchers at the Icahn School of Medicine at Mount Sinai, New York City; Dartmouth College, Hanover, NH; and University of California, Los Angeles. The study was published online Oct. 26 in the journal Annals of Internal Medicine.
Analyzing data from 1,702 Medicare beneficiaries, researchers found that the average total cost for deceased patients with dementia was $287,038 in the last five years of life. Similar costs for those with heart disease were $175,136; cancer, $173,383; other causes, $197,286.
In addition to higher total end-of-life costs, the study found that out-of-pocket spending for people with dementia was 81% higher than for those who died from other causes. Total costs include patient and family expenses, as well as Medicare and Medicaid expenditures.
"The discussion of healthcare reform must include the significant uninsured care needs of older adults with dementia and examine ways to mitigate the financial risk currently faced by Medicare beneficiaries," said Amy Kelley, MD, an associate professor of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai. She was the lead author of the study.
Diagnosing Lewy body dementia
James E. Galvin, M.D., M.P.H. (pictured above), a neuroscientist at Florida Atlantic University, has developed a test that can diagnose dementia with Lewy bodies and Parkinson's disease dementia in about three minutes.
The Lewy Body Composite Risk Score helps clinicians determine whether someone has bradykinesia, rigidity, postural instability or rest tremor without having to grade each extremity. The one-page survey provides structured yes/no questions related to six non-motor features that are present in patients with Lewy body dementia but are much less commonly found in other forms of dementia.
Galvin found that the test was able to discriminate between Alzheimer's disease and Lewy body dementia with 96.8% accuracy and provided sensitivity of 90% and specificity of 87%. He recently published his work in Alzheimer's & Dementia, the journal of the Alzheimer's Association.
"This new tool has the potential to provide a clearer, more accurate picture for those patients who are unable to be seen by specialists, hastening the correct diagnosis and reducing the strain and burden placed on patients and caregivers," said Galvin, a professor in the university's medical and nursing colleges. Early detection of the disease potentially could increase the effectiveness of interventions, he added.
Delaying residential care for those with Alzheimer's
Withdrawing a commonly prescribed Alzheimer's disease drug from someone in the advanced stages of the disease doubles his or her risk of being placed in a senior living community within a year, according to University College London research published Oct. 27 in Lancet Neurology.
The DOMINO trial found that withdrawing donepezil (available generically and also known by the brand name Aricept) doubled the risk of residential care placement after a year. Memantine (available generically and marketed under several brand names) was not found to affect risk of placement.
“Our previous work showed that, even when patients had progressed to the moderate or severe stages of their dementia, continuing with donezepil treatment provided modest benefits in cognitive function and in how well people could perform their daily activities,” said Robert Howard, professor of old age psychiatry at UCL. “Our new results show that these benefits translate into a delay in becoming dependent on residential care, a point that many of us dread. We are all impatient for the advent of true disease-modifying drugs that can slow or halt the Alzheimer process, but donepezil is available right now and at modest cost.”
The United Kingdom-based Alzheimer's Society recommends that “clinicians...consider the implications of this research and adjust their prescribing patterns accordingly.”