The Contribution of Neuropsychiatric Symptoms to the Cost of Frontotemporal, Alzheimer and Vascular Dementia Care

GALENO ROJAS, LEONARDO BARTOLONI, CECILIA SERRANO, CAROL DILLON, RICARDO ALLEGRI

Congreso; Annual Meeting American Academy of neurology; 2010

Background: Behavioral and psychological symptoms of dementia (BPSD) are highly prevalent in dementia. They are one of the main reasons for nursing home placement, which is the major component of the cost of dementia. Costs differences between the subtypes of dementia are not well known. Objective: To estimate the contribution of BPSD to the costs of care. Method : A five-year prospective study of resource utilization recorded by 104 caregivers of community dwelling patients with dementia. Patients were divided according diagnosis of probable Alzheimer´s disease (AD), frontotemporal (FTD) and vascular dementia (VD). BPSD were assessed by the neuropsychiatric inventory (NPI) and Beck depression inventory (BDI), cognition by Mini Mental State Exam (MMSE), function by activities of daily living (ADL) and caregiver’s burden by Zarit Inventory (ZI). The effect of behavior on direct costs of care was examined. Results : For all subtypes of dementia the incremental cost of a one-point increase in BDI was $44 per trimester. Nevertheless total NPI score didn’t show a significant increase of direct costs. There was a significant independent relationship between direct costs and caregiver’s burden, activities of daily life, depression and education (r2 =0.76). Sensitivity analysis using log-transformed costs did not change these results. In Alzheimer´s disease the incremental cost of a one-point increase in activities of daily living was $62 per trimester. For frontotemporal dementia variables leading to increased costs were lower MMSE, greater age and higher BDI (p<0.05). There weren’t significant independent variables for vascular dementias. Conclusion : Depression contributes significantly to the direct costs of dementia, particularly for frontotemporal dementia. The relationship between cognitive variables and costs are not the same in the different subtypes of dementia. Interventions targeted at BPSD may help to reduce the social costs of illness