Psychotropic drugs in patients with Alzheimer's Disease: a longitudinal study by the Registry of Dementias of Girona (ReDeGi) in Catalonia, Spain.

OBJECTIVES: Psychotropic drugs are usually prescribed to deal with behavioral and psychological symptoms of dementia, especially when nonpharmacologic approaches are not available or have limited efficacy. Poor outcomes and serious adverse events of the drugs used must be addressed, and risk-benefit ratios need to be considered. The aim of this longitudinal study was to describe the evolution of dispensation of psychotropic drugs in patients with Alzheimer's disease (AD) and to identify the associated demographic and clinical variables. METHODS: Longitudinal study using 698 cases with AD included in the Registry of Dementias of Girona in 2007 and 2008 and followed up during 3 years. Drugs were categorized according to the Anatomical Therapeutic Chemical classification. Binary logistic regression analyses were used to detect the variables associated with the use of antipsychotics, selective serotonin reuptake inhibitors (SSRIs), anxiolytics, and hypnotics. RESULTS: Of the patients, 51.2% consumed antipsychotics at least once during the three years of the study, whereas 73.3% and 58.2% consumed SSRIs and anxiolytics, respectively; 32.8% used hypnotics. Antipsychotic use was associated with a diagnosis of AD with delusions) [odds ratio (OR) = 5.7] and with increased behavior disorders (OR = 1.2). Patients with AD with depressed mood were more likely to be treated with SSRIs (OR = 3.1), while being a woman was associated with increased dispensation of anxiolytics (OR = 1.9) and SSRIs (OR = 2.2). CONCLUSIONS: Consumption of psychotropic drugs by the patients with AD registered in the Registry of Dementias of Girona is very high. Despite all the described adverse effects and recommendations of caution in their use, antipsychotics still are extensively used.

[Cognitive decline in Alzheimer's disease. A follow three or more years of a sample of patients]. / Declive cognitivo en la enfermedad de Alzheimer. Seguimiento de mas de tres años de una muestra de pacientes.

INTRODUCTION: The rates of cognitive decline in patients with Alzheimer's disease show variations due to various factors. AIM. To determine the influence of age, education, gender, activities of daily living (ADL) and acetylcholinesterase inhibitors (IAChE) and memantine in the rhythm and rate of cognitive decline. PATIENTS AND METHODS: Retrospective study of a sample of 383 patients with Alzheimer's disease, with neuropsychological assessments over three years. Cognitive measure was used as the Cambridge Cognitive Examination (CAMCOG). Patients were grouped according to their rate of annual decline (RAD) and performed a bivariate and multivariate regression analysis using as dependent variable the difference in scores on the CAMCOG (baseline-final). RESULTS: The younger age (beta = -0.23; p < 0.001), more educated (beta = 0.26; p < 0.001) and the greater deterioration of ADL (beta = 0.24; p < 0.001) were associated with a greater decline in all patients. The drugs had a beneficial effect (beta = -0.18; p = 0.011) in the group with lower and slower decline (RAD < 5%). CONCLUSIONS: The lower age, higher education and the deterioration of ADL are associated with a greater cognitive decline. The IAChE and memantine had a beneficial effect, slowing the decline in the group of patients with lower RAD.

TITLE: Declive cognitivo en la enfermedad de Alzheimer. Seguimiento de mas de tres años de una muestra de pacientes.Introduccion. Las tasas de declive cognitivo en los pacientes con enfermedad de Alzheimer presentan variaciones debido a diversos factores. Objetivo. Determinar la influencia de la edad, escolaridad, genero, actividades de la vida diaria (AVD) e inhibidores de la acetilcolinesterasa (IAChE) y memantina en el ritmo y tasas de declive cognitivo. Pacientes y metodos. Estudio retrospectivo de una muestra de 383 pacientes con enfermedad de Alzheimer, con evaluaciones neuropsicologicas durante un periodo superior a tres años. Se utilizo como medida cognitiva el Cambridge Cognitive Examination (CAMCOG). Se agruparon los pacientes segun su tasa de declive anual (TDA) y se realizaron analisis bivariante y de regresion lineal multivariante utilizando como variable dependiente la diferencia de puntuaciones en el CAMCOG (basal-final). Resultados. La menor edad (beta = ­0,23; p < 0,001), la mayor escolaridad (beta = 0,26; p < 0,001) y el mayor deterioro de las AVD (beta = 0,24; p < 0,001) estuvieron asociados a un mayor declive en todos los pacientes. Los farmacos tuvieron un efecto benefico (beta = ­0,18; p = 0,011) en el grupo con menor y mas lento declive (TDA < 5%). Conclusiones. La menor edad, la mayor escolaridad y el deterioro de las AVD se relacionan con un mayor declive cognitivo. Los IAChE y la memantina tuvieron un efecto benefico, enlenteciendo el declive en el grupo de pacientes con menor TDA.

Declive cognitivo en la enfermedad de Alzheimer. Seguimiento de más de tres años de una muestra de pacientes / Cognitive decline in Alzheimer’s disease. A follow three or more years of a sample of patients

Introducción. Las tasas de declive cognitivo en los pacientes con enfermedad de Alzheimer presentan variaciones debido a diversos factores. Objetivo. Determinar la influencia de la edad, escolaridad, género, actividades de la vida diaria (AVD) e inhibidores de la acetilcolinesterasa (IAChE) y memantina en el ritmo y tasas de declive cognitivo. Pacientes y métodos. Estudio retrospectivo de una muestra de 383 pacientes con enfermedad de Alzheimer, con evaluaciones neuropsicológicas durante un período superior a tres años. Se utilizó como medida cognitiva el Cambridge Cognitive Examination (CAMCOG). Se agruparon los pacientes según su tasa de declive anual (TDA) y se realizaron análisis bivariante y de regresión lineal multivariante utilizando como variable dependiente la diferencia de puntuaciones en el CAMCOG (basal-final). Resultados. La menor edad (β = –0,23; p < 0,001), la mayor escolaridad (β = 0,26; p < 0,001) y el mayor deterioro de las AVD (β = 0,24; p < 0,001) estuvieron asociados a un mayor declive en todos los pacientes. Los fármacos tuvieron un efecto benéfico (β = –0,18; p = 0,011) en el grupo con menor y más lento declive (TDA < 5%). Conclusiones. La menor edad, la mayor escolaridad y el deterioro de las AVD se relacionan con un mayor declive cognitivo. Los IAChE y la memantina tuvieron un efecto benéfico, enlenteciendo el declive en el grupo de pacientes con menor TDA (AU)

Introduction. The rates of cognitive decline in patients with Alzheimer’s disease show variations due to various factors. Aim. To determine the influence of age, education, gender, activities of daily living (ADL) and acetylcholinesterase inhibitors (IAChE) and memantine in the rhythm and rate of cognitive decline. Patients and methods. Retrospective study of a sample of 383 patients with Alzheimer’s disease, with neuropsychological assessments over three years. Cognitive measure was used as the Cambridge Cognitive Examination (CAMCOG). Patients were grouped according to their rate of annual decline (RAD) and performed a bivariate and multivariate regression analysis using as dependent variable the difference in scores on the CAMCOG (baseline-final). Results. The younger age (β = –0.23; p < 0.001), more educated (β = 0.26; p < 0.001) and the greater deterioration of ADL (β = 0.24; p < 0.001) were associated with a greater decline in all patients. The drugs had a beneficial effect (β = –0.18; p = 0.011) in the group with lower and slower decline (RAD < 5%). Conclusions. The lower age, higher education and the deterioration of ADL are associated with a greater cognitive decline. The IAChE and memantine had a beneficial effect, slowing the decline in the group of patients with lower RAD (AU)

Valor económico anual de la asistencia informal en la enfermedad de Alzheimer / Annual economic cost of informal care in Alzheimer’s disease

Introducción. El coste indirecto asociado a la atención de los pacientes con enfermedad de Alzheimer (EA) lo asume principalmente la familia. Objetivo. Describir el coste asociado al tiempo de dedicación, su evolución anual, las características y la carga del cuidador asociada. Sujetos y métodos. Pacientes diagnosticados de EA no institucionalizados, seguidos ambulatoriamente en una unidad de diagnóstico y sus cuidadores principales. Estudio prospectivo y observacional de 12 meses de evolución. Se evaluaron las características clínicas del paciente a través del Cambrigde Cognitive Examination Revised, para la capacidad cognitiva; el Disability Assessment in Dementia, para la capacidad funcional, y el inventario neuropsiquiátrico, para los trastornos no cognitivos. Se recogieron los datos sociodemográficos a través del Cambridge Examination for Mental Disorders of the Elderly Revised. Se registró la dedicación del cuidador, sus características sociodemográficas y la carga (a través de la escala de Zarit). Resultados. La muestra estuvo formada por 169 pacientes y 169 cuidadores. El coste en el momento basal fue de 6.364,8 €/año, asociado principalmente al apoyo en actividades instrumentales. A los 12 meses se observó un incremento global del 29% (1.846,8 €/año). El incremento del coste se asoció a la discapacidad física (F = 25,2; gl = 1; p < 0,001), el deterioro cognitivo (F = 8,5; gl = 1; p = 0,004), la edad del paciente (F = 9,2; gl = 1; p = 0,003) y si el cuidador era o no el único (F = 20,4; gl = 1; p < 0,001). El coste de la asistencia explicó el 6,7% de la varianza total de la carga percibida por los cuidadores. Conclusiones. El coste indirecto medio de la atención fue de 6.364,8 €/año, con un incremento del 29% anual que se asoció a la discapacidad física y cognitiva, a la edad del paciente y a tener un solo cuidador (AU)

Introduction. The indirect cost associated with the care of patients with Alzheimer’s disease is taken on primarily by the family. Aim. To describe the cost associated with time dedication, its annual evolution, associated characteristics and related caregiver burden. Subjects and methods. Non-institutionalized patients diagnosed with Alzheimer’s disease who are managed on an outpatient basis in a diagnosis unit and their primary caregivers. Prospective and observational study conducted over 12 months. The patient’s clinical features were assessed using the Cambrigde Cognitive Examination Revised for cognitive capacity, the Disability Assessment in Dementia for functional capacity and the Neuropsychiatric Inventory for non-cognitive disorders. Sociodemographic data were collected by means of the Cambridge Examination for Mental Disorders of the Elderly Revised. The caregiver’s dedication, sociodemographic characteristics and burden (by means of the Zarit interview) were recorded. Results. Sample comprised of 169 patients and 169 caregivers. The cost at baseline was 6364.8 €/year, and was mainly associated with support in instrumental activities. At 12 months, an overall increase of 29% was observed (1846.8 €/year). Cost increase was associated with physical (F = 25.2; df = 1; p < 0.001) and cognitive (F = 8.5; df = 1; p = 0.004) disability, patient age (F = 9.2; df = 1; p = 0.003) and with whether the caregiver was the only caregiver or not (F = 20.4; df = 1; p < 0.001). The cost of care explained 6.7% of the total variance of the burden perceived by caregivers. Conclusions. Care has a mean indirect cost of 6364.2 €/year, with an annual increase of 29% that was associated with physical and cognitive disability, patient age and having one single caregiver (AU)

[Annual economic cost of informal care in Alzheimer's disease]. / Valor económico anual de la asistencia informal en la enfermedad de Alzheimer.

INTRODUCTION: The indirect cost associated with the care of patients with Alzheimer's disease is taken on primarily by the family. AIM: To describe the cost associated with time dedication, its annual evolution, associated characteristics and related caregiver burden. SUBJECTS AND METHODS: Non-institutionalized patients diagnosed with Alzheimer's disease who are managed on an out-patient basis in a diagnosis unit and their primary caregivers. Prospective and observational study conducted over 12 months. The patient's clinical features were assessed using the Cambrigde Cognitive Examination Revised for cognitive capacity, the Disability Assessment in Dementia for functional capacity and the Neuropsychiatric Inventory for non-cognitive disorders. Sociodemographic data were collected by means of the Cambridge Examination for Mental Disorders of the Elderly Revised. The caregiver's dedication, sociodemographic characteristics and burden (by means of the Zarit interview) were recorded. RESULTS: Sample comprised of 169 patients and 169 caregivers. The cost at baseline was 6364.8 euro/year, and was mainly associated with support in instrumental activities. At 12 months, an overall increase of 29% was observed (1846.8 euro/year). Cost increase was associated with physical (F = 25.2; df = 1; p < 0.001) and cognitive (F = 8.5; df = 1; p = 0.004) disability, patient age (F = 9.2; df = 1; p = 0.003) and with whether the caregiver was the only caregiver or not (F = 20.4; df = 1; p < 0.001). The cost of care explained 6.7% of the total variance of the burden perceived by caregivers. CONCLUSIONS: Care has a mean indirect cost of 6364.2 euro/year, with an annual increase of 29% that was associated with physical and cognitive disability, patient age and having one single caregiver.

Deterioro cognitivo leve. ¿Realidad o ficción? / No disponible

No disponible

Syndromic association of behavioral and psychological symptoms of dementia in Alzheimer disease and patient classification.

OBJECTIVES: To identify patient groups with Alzheimer disease (AD) according to the presence of psychological and behavioral syndromes and to determine the clinical differences among these groups. METHODS: Cross-sectional and observational study of 491 patients with probable AD whom were administered the Neuropsychiatric Inventory (NPI) at the baseline visit and reevaluated after 12 months. RESULTS: Principal component analysis (PCA) of baseline NPI data revealed three factors, including a psychosis factor (delusions, hallucinations, and aberrant motor behavior), a depressive factor (depression, anxiety, irritability, agitation, and apathy) and a hypomanic factor (euphoria and disinhibition). Cluster analysis of factor scores indicated the presence of three patient groups: one group was characterized by low scores in factors, a second group including patients with high scores in the depressive factor, and a third group that included patients with high scores in the three factors. The PCA of the NPI scores carried out after 1 year showed the persistence of the three factors. The cluster analysis of their factor scores also showed the presence of the same three patient groups but with a few differences in certain symptoms. A higher frequency of personal psychiatric history but no family history was observed in the cluster with depressive symptoms. CONCLUSIONS: Three neuropsychiatric syndromes have been identified, which have made it possible to classify patients with AD in three distinct large groups. A temporal stability is evidenced among the group with low symptoms. Patients with high scores in depressive factor or in three factors showed greater temporal instability. Certain differences among the groups suggest that different physiopathogenic mechanisms may be involved in neuropsychiatric syndromes.

Perfil cognitivo en la fibromialgia. Comparación con un grupo con deterioro cognitivo leve / Cognitive profile in fibromyalgia. Comparison with a mild cognitive impairment group

Objetivo: Los objetivos de este trabajo fueron realizar una evaluación neuropsicológica de pacientes con fibromialgia (FM) con quejas subjetivas de pérdida de memoria y compararlos con un grupo de deterioro cognitivo leve (DCL) sin FM. Material y método: Estudio retrospectivo. Se evaluó a 32 pacientes con FM y 86 pacientes con DCL sin FM. Se administró una batería neuropsicológica. Se comparó el grupo con FM con un grupo control con DCL (n=86) sin FM. Resultados: Se evidenció un deterioro cognitivo leve en 29 de las 32 mujeres con FM y el patrón neuropsicológico mostró una afectación en atención, memoria y función ejecutiva. Cuando comparamos el perfil neuropsicológico con el grupo con DCL sin FM, observamos que la muestra con FM presenta una mayor afectación en memoria, en función ejecutiva, y una menor afectación en función premotora. Conclusión: La exploración neuropsicológica evidenció una alteración cognitiva leve en la mayoría de las mujeres con FM con quejas subjetivas de pérdida de memoria (90,5%). El patrón neuropsicológico obtenido es de predominio subcortical, con afectación de la memoria y de la función ejecutiva. La muestra con FM presenta unos resultados cognitivos similares al grupo con DCL (AU)

Objective: The neuropsychological assessment of patients with fibromyalgia (FM) and with subjective cognitive complaints was analyzed. The group was compared with a mild cognitive impairment (MCI) group without FM. Material and method: Retrospective study of 32 patients with FM were evaluated and 86 patients with MCI without FM. A neuropsychological test battery was administered. Results were compared with a control group of MCI (n=86) without FM. Results: Evidence of MCI was observed in 29 of 32 women with FM, and the neuropsychological pattern showed a major impairment on attention, memory and executive function. When the neuropsychological pattern was compared with the MCI group without FM, we found that patients with FM presented a higher rate of impairment of memory and executive function, and less impairment of the premotor function. Conclusions: The neuropsychological evaluation showed an MCI in the majority of women with FM with a subjective complaint of memory loss (90,5%). The neuropsychological pattern was predominantly subcortical with impairment of memory and executive function. The sample of patients with FM presented cognitive results similar to the MCI group (AU)

[Cognitive profile in fibromyalgia. Comparison with a mild cognitive impairment group]. / Perfil cognitivo en la fibromialgia. Comparación con un grupo con deterioro cognitivo leve.

OBJECTIVE: The neuropsychological assessment of patients with fibromyalgia (FM) and with subjective cognitive complaints was analyzed. The group was compared with a mild cognitive impairment (MCI) group without FM. MATERIAL AND METHOD: Retrospective study of 32 patients with FM were evaluated and 86 patients with MCI without FM. A neuropsychological test battery was administered. Results were compared with a control group of MCI (n=86) without FM. RESULTS: Evidence of MCI was observed in 29 of 32 women with FM, and the neuropsychological pattern showed a major impairment on attention, memory and executive function. When the neuropsychological pattern was compared with the MCI group without FM, we found that patients with FM presented a higher rate of impairment of memory and executive function, and less impairment of the premotor function. CONCLUSIONS: The neuropsychological evaluation showed an MCI in the majority of women with FM with a subjective complaint of memory loss (90,5%). The neuropsychological pattern was predominantly subcortical with impairment of memory and executive function. The sample of patients with FM presented cognitive results similar to the MCI group.

Trazodone for Alzheimer's disease: a naturalistic follow-up study.

This study intended to provide a patient profile for trazodone (a triazolopyridine-derivative of phenylpiperazine) prescription in everyday clinical practice in patients with Alzheimer's disease (AD), and to describe clinical evaluation and the impact on caregiver burden at a 6-month follow-up. A naturalistic, prospective and observational study was performed, with a 6-month follow-up in 396 patients with probable AD, according to the NINCDS-ARDRA criteria. At the baseline and at the 6-month visit, patients were administered the Neuropsychiatric Inventory (NPI) to determine their Behavioral and Psychological Symptoms of Dementia (BPSD), and the Zarit Burden Interview (ZBI) to assess the impact on caregiver burden. Trazodone was prescribed for 6.1% of patients. With respect to the baseline visit, the untreated group showed an increased global NPI score (3.1 points; 95% CI=1.9-4.2; p=0.001) and ZBI score (2.2 points; 95% CI=0.9-3.4; p=0.001). At 6 months, the global NPI and ZBI scores remained unchanged for the treated group. The treated group showed a significant reduction in the NPI irritability subscale score (2.1 points; 95% CI=0.4-3.7; p=0.015). In the clinical practice, trazodone treatment was prescribed for patients with irritability, agitation and disinhibition. After 6 months, patients treated with trazodone exhibited no increase in BPSD frequency or severity, nor was an increase noted in the caregiver burden.

[Mortality-associated factors in patients with Alzheimer's disease treated with galantamine]. / Factores asociados a la mortalidad en pacientes con enfermedad de Alzheimer tratados con galantamina.

BACKGROUND AND OBJECTIVE: To study the effect of clinical and demographic variables on mortality in patients with probable Alzheimer's disease treated with the cholinesterase inhibitor galantamine. PATIENTS AND METHOD: This retrospective cohort study reviewed 172 medical records, gathering information such as demographic and clinical variables, adverse events, number of withdrawals and duration of treatment with galantamine. RESULTS: Of 172 patients, 18.6% had adverse events. Galantamine was well tolerated in 15.4% of patients but they abandoned the treatment because of several reasons after a median duration of treatment of 13.3 months and an average dose of 15.0 mg/day. The overall rate of mortality was 12.5%, being, 19.0% for those who abandoned the treatment and 11.3% for those who dit not. The univariate analysis showed that patients who died were older, had had more antipsychotic medications, had a higher total Blessed score and had suffered from more episodes of heart failure. The associated variables in the multivariate analysis using a binary logistic regression were mortality, sex, age, hypertension, heart failure, arrhythmia, antipsychotic treatment and greater cognitive impairment. CONCLUSIONS: The duration and the dose of treatment with galantamine were not associated with increased mortality. Related variables were an advanced age, male sex, cardiovascular diseases and antipsychotic treatment.

Factores asociados a la mortalidad en pacientes con enfermedad de Alzheimer tratados con galantamina / Mortality-associated factors in patients with Alzheimer's disease treated with galantamine

Fundamento y objetivo: El propósito del presente trabajo ha sido estudiar el efecto de variables clínicas y demográficas en la mortalidad en pacientes con enfermedad de Alzheimer tratados con galantamina. Pacientes y método: Se ha realizado un estudio de cohorte retrospectivo a partir de la revisión de las historias clínicas de una muestra de pacientes diagnosticados de enfermedad de Alzheimer a quienes se había prescrito tratamiento con galantamina. Se recogió información sobre diversas variables demográficas y clínicas y sobre los acontecimientos adversos, abandonos y duración del tratamiento con fármacos anticolinesterásicos. Resultados: La muestra estuvo formada por 172 pacientes, de los que el 18,6% presentó intolerancia a la galantamina. El 15,4% de los pacientes que la toleraron abandonó el tratamiento por diversos motivos tras una duración media de 13,3 meses y una dosis media de 15,0 mg/día. La tasa de mortalidad total fue del 12,5%; la tasa en los pacientes que abandonó el tratamiento fue del 19,0% y en los que no lo abandonaron del 11,3%. El análisis univariante mostró que los fallecidos tenían una mayor edad y puntuación más elevada en la escala de Blessed, y que entre ellos era mayor el número de casos con insuficiencia cardíaca y el de casos tratados con antipsicóticos. El análisis multivariante mediante regresión logística binaria identificó como variables asociadas a la mortalidad el sexo, la edad, la hipertensión arterial, la insuficiencia cardíaca, la arritmia, el tratamiento con antipsicóticos y un mayor deterioro cognitivo. Conclusiones: El tiempo y la dosis de tratamiento con galantamina no se asociaron a un incremento de la mortalidad. Las variables relacionadas con ésta fueron la edad avanzada, el sexo masculino, los trastornos cardiovasculares y el tratamiento con fármacos antipsicóticos

Background and objective: To study the effect of clinical and demographic variables on mortality in patients with probable Alzheimer's disease treated with the cholinesterase inhibitor galantamine. Patients and method: This retrospective cohort study reviewed 172 medical records, gathering information such as demographic and clinical variables, adverse events, number of withdrawals and duration of treatment with galantamine. Results: Of 172 patients, 18.6% had adverse events. Galantamine was well tolerated in 15.4% of patients but they abandoned the treatment because of several reasons after a median duration of treatment of 13.3 months and an average dose of 15.0 mg/day. The overall rate of mortality was 12.5%, being, 19.0% for those who abandoned the treatment and 11.3% for those who dit not. The univariate analysis showed that patients who died were older, had had more antipsychotic medications, had a higher total Blessed score and had suffered from more epidodes of heart failure. The associated variables in the multivariate analysis using a binary logistic regression were mortality, sex, age, hypertension, heart failure, arrhythmia, antipsychotic treatment and greater cognitive impairment. Conclusions: The duration and the dose of treatment with galantamine were not associated with increased mortality. Related variables were an advanced age, male sex, cardiovascular diseases and antipsychotic treatment

[Cost relation between severity of Alzheimer's disease and cognitive and functional impairment]. / Análisis de los costes de la enfermedad de Alzheimer en función del deterioro cognitivo y funcional.

BACKGROUND AND OBJECTIVE: This study aims to identify the relationship between costs of medical and social attention in patients with dementia of Alzheimer disease (AD) type and clinical and sociodemographic data of patients and their caregivers. PATIENTS AND METHOD: It was an analytic observational study in a cohort of patients diagnosed with Alzheimer's disease who received ambulatory attention. Information about the use of health-related resources was collected and costs were estimated from a societal perspective. Indirect costs were calculated using a replacement cost approach. Patients and caregivers were examined with the Mini-Mental State Examination (MMSE), the Rapid Disability Rating Scale (RDRS-2), the Neuropsychiatric Inventory (NPI), the Burden Interview (BI) and the Resource Utilization in Dementia (RUD). Patients were grouped taking into account the score obtained in the MMSE. RESULTS: A cohort of 417 patients, mean age (SD) 75.2 (6.6) years, 71% females, was studied. Disease severity levels were distributed as follows: MMSE, 26% for MMSE > 19, 66% for MMSE = 19-11, and 8% for MMSE < 11. 69% of caregivers were women, with a mean age of 57.1 (15.8) years. The cost per patient and per month was estimated to be 419.3 Euro for MMSE > 19, 641.9 Euro for MMSE = 19-11, and 1150.6 Euro for MMSE < 11. CONCLUSIONS: The societal cost of AD increases dramatically with increasing disease severity. Caregiver burden and sex as well as the marital status of patients are associated with the cost of the disease.