Longitudinal costs of caring for people with Alzheimer's disease.

BACKGROUND: There has been an increasing interest in the relationship between severity of disease and costs in the care of people with dementia. Much of the current evidence is based on cross-sectional data, suggesting the need to examine trends over time for this important and growing cohort of the population. METHODS: This paper estimates resource use and costs of care based on longitudinal data for 72 people with dementia in Ireland. Data were collected from the Enhancing Care in Alzheimer's Disease (ECAD) study at two time points: baseline and follow-up, two years later. Patients' dependence on others was measured using the Dependence Scale (DS), while patient function was measured using the Disability Assessment for Dementia (DAD) scale. Univariate and multivariate analysis were used to explore the effects of a range of variables on formal and informal care costs. RESULTS: Total costs of formal and informal care over six months rose from €9,266 (Standard Deviation (SD): 12,947) per patient at baseline to €21,266 (SD: 26,883) at follow-up, two years later. This constituted a statistically significant (p = 0.0014) increase in costs over time, driven primarily by an increase in estimated informal care costs. In the multivariate analysis, a one-point increase in the DS score, that is a one-unit increase in patient's dependence on others, was associated with a 19% increase in total costs (p = 0.0610). CONCLUSIONS: Higher levels of dependence in people with Alzheimer's disease are significantly associated with increased costs of informal care as the disease progresses. Formal care services did not respond to increased dependence in people with dementia, leaving it to families to fill the caring gap, mainly through increased supervision with the progress of disease.

Detecting prodromal Alzheimer's disease in mild cognitive impairment: utility of the CAMCOG and other neuropsychological predictors.

BACKGROUND: The Cambridge cognitive examination (CAMCOG) is a mini neuropsychological battery which is well established and widely used. The utility of the CAMCOG in detecting prodromal Alzheimer's disease (AD) in patients with mild cognitive impairment (MCI) has not been determined. The objectives of this study are: to establish which subtests of cognitive domains contained within the CAMCOG are predictive of conversion to AD, to compare these with an extended version of the delayed word recall (DWR) test and to establish optimal cut points for all measures used. METHODS: 182 patients with MCI were identified from consecutive referrals to a memory clinic. Logistic regression, cox regression and receiver operating characteristic curve (ROC) analyses were conducted. RESULTS: The DWR displayed the best sensitivity (77%) and specificity (76%). The composite memory score contained within the CAMCOG achieved similar sensitivity (78%) and specificity (74%). The recognition component of the extended DWR demonstrated good specificity (85%) but poor sensitivity (57%). The optimal predictive model combined category fluency with the DWR and achieved predictive accuracy of 83%. CONCLUSION: The DWR, which is a test specifically designed to have high predictive accuracy for AD, performed best. The composite measure of memory contained within the CAMCOG performed similarly well. The DWR has the advantage of being brief, easy to administer and suitable for use in non-specialist settings. The CAMCOG takes longer to administer but provides information regarding additional cognitive domains and is sensitive to change over time. Category fluency may be usefully combined with the DWR to improve predictive accuracy.

Late life depression: a comparison of risk factors and symptoms according to age of onset in community dwelling older adults.

BACKGROUND: It has been reported that late onset depression is more frequently associated with acquired organic pathology and that patients are less likely to report a family history of depression. Differences in phenomenology according to age of onset have been described although these have not been consistently replicated. The majority of these studies have been in hospital populations. The aim of this study is to address this question in a sample of community dwelling older adults. METHODS: 89 subjects with GMS-AGECAT depression were identified from a sample of 1231 community dwelling adults aged 65 years and over. Subjects were analysed across a range of aetiological and phenomenological variables according to age of onset of first depressive episode. RESULTS: Subjects with late onset depression (≥ 60) were significantly less likely to report a family history of depression, were less likely to report previous hospitalisation for depression and had greater cognitive impairment. Late onset subjects were also less likely to report feelings of guilt or thoughts that life was not worth living in the previous month. CONCLUSION: While we found that patients with late onset depression differed from early onset patients according to certain aetiological risk factors, we did not find a distinctive profile of depressive symptomatology which might be considered clinically useful at an individual level. These findings are consistent with studies based in hospital populations.

Social capital and suicide in 11 European countries: an ecological analysis.

BACKGROUND: "Social capital" refers to the existence of voluntary community networks and relationships based on trust, and the use of these networks and relationships to enable positive social action. Social capital is positively associated with selected indices of mental health. METHODS: We performed an ecological investigation of the relationship between social trust (as one component of social capital) and national suicide rates in 11 European countries (n=22,227). RESULTS: There was an inverse relationship between social trust and national suicide rates (i.e. the higher the social trust, the lower was the suicide rate), after controlling for gender, age, marriage rates, standardised income and reported sadness. CONCLUSIONS: Social capital may have a protective effect against suicide at the national level. Multi-level analysis, taking into account both group-level and individual-level variables, would help clarify this relationship further and guide appropriate interventions at both the group and individual levels.