"iDoctor – Medical Blog"

Objectives: To estimate long-term care costs and disease progression among Medicare beneficiaries aged 65+ with ADRD. Methods: Retrospective analysis of Medicare Part A claims and nursing home (NH) Minimum Data Set (MDS) records among beneficiaries 1999-2007. Expenditures were grouped into 3 periods; PRE, events occurring between date of ADRD diagnosis, before first NH admission; PERI, from first NH admission to at least 100 days; and, PERM, after 120 days. Utilization and reimbursements were computed for each period. Results: Demographics of the3,681,702 ADRD beneficiaries showed average age of 83 (+/–7), female (67.7%) and white (87.4%). Medicare reimbursements per person increased by 58% from the PRE ($47,912) to PERM period ($75,654). Age, ethnicity, gender (male), and comorbidities were significantly related to total reimbursements in each phase. Conclusions: Applying a taxonomy of NH phases, Medicare expenditures per person year are higher among patients in their terminal phase and higher still with comorbidities.

In Alzheimer’s disease (AD), nonverbal aspects of communication become increasingly important in caregiver–patient interactions when the ability to communicate verbally is fading with progression of the disease. We therefore investigated the impact of cognitive deficits and neuropsychiatric symptoms, particularly apathy, on facial expression in AD. While overall neuropsychiatric symptoms were not associated with facial expression, apathy exhibited substantial correlations, even after controlling for cognitive deficits. Moreover, apathy appeared to moderate the influence of cognitive deficits: without considering apathy, cognitive deficits were associated with less specific facial expressions. After controlling for apathy, cognitive decline was related to increased facial expressiveness. In conclusion, apathetic symptoms appear to be specifically associated with facial expression in AD and thus could contribute to a disregard for patients’ needs in everyday life.

Several data suggest that physical activity and cognitive stimulation have a positive effect on the quality of life (QoL) of people with Alzheimer’s disease (AD), slowing the decline due to the disease. A pilot project was undertaken to assess the effect of cognitive stimulation, physical activity, and socialization on patients with AD and their informal caregiver’s QoL and mood. Fourteen patients with AD were randomly divided into active treatment group and control group. At the end of treatment, a significant improvement in apathy, anxiety, depression, and QoL in the active treatment group was found. Considering caregivers, those of the active treatment group exhibited a significant improvement in their mood and in their perception of patients’ QoL. This study provides evidence that a combined approach based on cognitive stimulation, physical activity, and socialization is a feasible tool to improve mood and QoL in patients with AD and their caregivers.

A social ecological model was used to predict facilitators’ behaviors observed during Alzheimer’s Association sponsored family support group meetings (N = 66). Information about group leaders was obtained via individual telephone interview prior to the observation of their support group by trained raters. Family dementia caregivers (N = 296) provided basic demographic and caregiving-related information at the end of the observed meeting. Caregiver- and group-level variables predicted ratings of observed leader support during support group meetings. The addition of leader characteristics such as years of experience or professional roles did not significantly contribute to the model. This study lends credence to ecological models emphasizing the influence of social context. Recommendations are made for facilitator training and management of Alzheimer’s Association sponsored support group meetings.

Nowadays, preventing the effects of mental decline is an international priority, but there is little research into cognitive training in mild cognitive impairment (MCI). We present the results of a program aimed at teaching memory strategies and improving metacognitive abilities. This was associated with training to ameliorate caregivers’ assistance. Two groups (A and B) were compared in a crossover design. After the first evaluation, group A (but not B) participated in a 6-month cognitive stimulation program. After a second assessment, only B received treatment and then a final evaluation was carried out on both the groups. The results show that (1) both the groups improved their performance as an effect of training; (2) improvements are specific to the functions trained; (3) in the interval without intervention, performance of group B worsened; and (4) group A has maintained their results over time. In conclusion, our results show that specific training may reduce memory impairment in MCI.

Background: Prevalence of cognitive impairment and dementia has not been studied in Bulgaria up to date. A 2-phase cross-sectional study was designed in order to determine the prevalence of dementia, its subtypes, and mild cognitive impairment in a Bulgarian population. Methods: The study sample consisted of 605 participants over the age of 65, residents of the city of Varna. A total of 540 participants (89%) completed the screening phase of the study. All positive screens and a control group were included in the diagnostic phase of the study, where comprehensive neuropsychological, clinical, and imaging assessments were performed. Results: Dementia was diagnosed in 39 persons (7.2%) and 36 had mild cognitive impairment (6.7%). Alzheimer’s disease was the most frequent type of dementia (3.1%), followed by vascular dementia (2.0%). Discussion: Our results support the hypothesis that prevalence of vascular cognitive impairment may be higher in Bulgaria than in most European countries.

Publication year: 2012
Source:The American Journal of Geriatric Pharmacotherapy, Volume 10, Issue 2