Alzheimer Disease: Colenda CC

Lyketsos CG, Colenda CC, Beck C, Blank K, Doraiswamy MP, Kalunian DA, Yaffe K, Anonymous00013. · No affiliation provided · Am J Geriatr Psychiatry. · Pubmed #16816009 No free full text.

This publication has no abstract.

Murman DL, Colenda CC. · Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska 68198-2045, USA. · Pharmacoeconomics. · Pubmed #15836005 No free full text.

Abstract: The majority of patients with Alzheimer's disease (AD) will have clinically significant neuropsychiatric symptoms during the course of their disease. There is growing evidence that neuropsychiatric symptoms increase direct costs of care in patients with AD, especially the costs associated with formal long-term care and unpaid caregiving. For example, we have estimated that a 1-point worsening of the neuropsychiatric inventory score is associated with an incremental increase of between USD 247 and USD 409 per year in total direct costs of care based upon year 2001 US dollars, depending on the value of unpaid caregiving. Although data are still limited, there have been a series of well designed, controlled clinical trials that have established the efficacy of several drugs used in the treatment of neuropsychiatric symptoms in patients with AD. The economic impact of using efficacious drugs to treat neuropsychiatric symptoms in patients with AD has not been evaluated formally. To successfully complete formal economic evaluations of these drugs there is a need for more research to refine methods for determining the economic value of unpaid caregiving and to collect more data concerning the incremental effects of neuropsychiatric symptoms on QOL, costs of care and survival. The current ongoing treatment trials that are collecting economic and QOL data as a part of the trial will be able to perform cost-effectiveness and cost-utility analyses of these new efficacious drugs. These economic evaluations will provide important information for decision makers who are formulating healthcare policy for the treatment of patients with AD.

Johnson KC, Margolis KL, Espeland MA, Colenda CC, Fillit H, Manson JE, Masaki KH, Mouton CP, Prineas R, Robinson JG, Wassertheil-Smoller S, Anonymous00157. · Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennesse 38163, USA. · J Am Geriatr Soc. · Pubmed #18637980 No free full text.

Abstract: OBJECTIVES: To examine the relationship between baseline hypertension, blood pressure, and the development of cognitive decline in participants in the Women's Health Initiative Memory Study (WHIMS). DESIGN: Prospective analyses. SETTING: Thirty-nine centers. PARTICIPANTS: Seven thousand one hundred forty-nine women aged 65 and older. MEASUREMENTS: The Modified Mini-Mental State Examination (3MS) was used to assess global cognitive functioning. Participants who scored below pre-established cutpoints were scheduled for more-extensive neurocognitive assessments. Results from these assessments were centrally adjudicated. RESULTS: The mean age of this group of 7,149 participants at baseline was 71.0 +/- 3.8, and the mean 3MS score was 95.2 +/- 4.3. During a mean follow-up period of 4.5 years, women without hypertension tended to have slightly higher 3MS scores than women with hypertension (P=.001), but the difference was not seen after adjustment for covariates (P=.17). Women with hypertension also appeared to be at greater risk for probable dementia or mild cognitive impairment (MCI) (hazard ratio=1.35, 95% confidence interval=1.07-1.70, P=.01), although when potential cofounders were accounted for, this association was no longer significant (P=.06). CONCLUSION: Hypertension and high blood pressure at baseline were not independently associated with MCI or probable dementia over time in older, cognitively intact, postmenopausal women enrolled in WHIMS after other potential confounders were taken into account. These analyses should not be viewed as discouraging appropriate medical treatment for hypertension.

Tun SM, Murman DL, Colenda CC. · Department of Psychology, Michigan State University, East Lansing, MI, USA. · Am J Geriatr Psychiatry. · Pubmed #18591579 No free full text.

Abstract: OBJECTIVE: In a previously published study, the authors conceptualized neuropsychiatric symptoms in Alzheimer disease (AD) patients as distinct symptom profiles with differential outcomes. In the present study, our aim was to further examine the validation of the classification by considering its concurrent validity on caregiver burden. METHOD: As described previously, neuropsychiatric symptoms, as assessed by the Neuropsychiatric Inventory, in 122 patients with AD were categorized, using cluster analysis. The presence as well as the severity and frequency of symptoms were both used in the classification. After the classification, group differences in caregiver burden, as measured by Screen for Caregiver Burden, were tested using analysis of covariance. The effects of important covariates, such as functional impairment, comorbid medical conditions, parkinsonism, age, and cognitive functioning, were examined. RESULTS: Based on the presence of symptoms, subgroups differed in the level of caregiver distress in that caregivers of the "minimally symptomatic" and the "affective/apathetic" subgroups experienced less distress than the caregivers of the "highly symptomatic" subgroup. Based on the severity and frequency of symptoms, subgroups differed in such a way that caregivers of the "minimally symptomatic" and the "predominantly apathetic" subgroups endorsed less distress than the caregivers of the "affective" and the "highly symptomatic" subgroups. CONCLUSION: Neuropsychiatric subgroups were able to differentially predict caregiver burden. The findings appear to lend further support to the validity of classifying neuropsychiatric symptoms in AD patients using cluster analysis.

Tun SM, Murman DL, Long HL, Colenda CC, von Eye A. · From Departments of Psychology, Michigan State University, East Lansing, MI, USA. · Am J Geriatr Psychiatry. · Pubmed #17384314 No free full text.

Abstract: OBJECTIVE: The aim of the study was to conceptualize neuropsychiatric symptoms in patients with Alzheimer disease as distinct symptom profiles with differential disease outcomes. Two outcomes of interest in the study were nursing home placement and survival. METHOD: Cluster analysis was used to categorize 122 patients with Alzheimer disease based on their neuropsychiatric symptoms as assessed by the Neuropsychiatric Inventory. Both the presence as well as the severity and frequency of symptoms were considered. After identification of the subgroups, the predictive validity of the categorization was tested on time to nursing home placement and time to death over a three-year period. Cox proportional hazard models were used to perform survival analysis. Important covariates such as severity of cognitive and functional impairments, comorbid medical conditions, presence of parkinsonism, and marital status were adjusted at baseline. RESULTS: Based on the presence of neuropsychiatric symptoms, three subgroups were identified: minimally symptomatic, highly symptomatic, and affective/apathetic. Over a three-year period, the highly symptomatic group had an increased risk of nursing home placement. In addition, the rates of survival were significantly lower for the highly symptomatic and the affective/apathetic subgroups. Based on the severity and frequency of symptoms, two-cluster and four-cluster solutions were produced. The groupings based on severity and frequency of symptoms predicted significant differential outcomes in survival and nursing home placement. CONCLUSIONS: Neuropsychiatric subgroups were able to predict differential outcomes and identify those with an increased risk for a worse prognosis. The findings were discussed through their research and clinical implications.

Murman DL, Von Eye A, Sherwood PR, Liang J, Colenda CC. · Department of Neurological Sciences, University of Nebraska Medical Center, 982045 Nebraska Medical Center, Omaha, NE 68198, USA. · Alzheimer Dis Assoc Disord. · Pubmed #17334271 No free full text.

Abstract: The purpose of this study was to examine the strength of the associations between 5 measures of need that are potentially modifiable in degenerative dementia patients and direct costs of care from 5 payer perspectives in the US healthcare system. Data were derived from a cohort study of 150 patients with a degenerative dementia. We measured need variables at baseline and utilization of healthcare in the year before and after baseline. Utilization data were converted into estimated direct costs and totaled based on the costs paid for by 5 payers in the US healthcare system. Path models were used to quantify and compare the relationships between need variables and direct costs. From Medicare's perspective, comorbid medical conditions were the most important predictor of Medicare costs. From Medicaid's perspective, neuropsychiatric symptoms and signs of parkinsonism were additional significant predictors. From the perspective of patients, their families and society, all 5 need variables were significant predictors of direct costs (ie, those above, plus cognitive impairment, and dependency). The relationship between evaluated need variables and direct costs depends on the perspective of the payer and provide insights into which need variables could be targeted with interventions to control costs and improve patient outcomes.

Murman DL, Kuo SB, Powell MC, Colenda CC. · Department of Neurology, Michigan State University, East Lansing, MI 48824, USA. · Neurology. · Pubmed #14557565 No free full text.

Abstract: OBJECTIVE: To compare the annual direct costs for patients with Alzheimer's disease (AD) and no parkinsonism (AD), patients with AD and parkinsonism (AD/P), and patients with dementia with Lewy bodies (DLB). For the entire sample, the authors examined the incremental costs associated with increasing parkinsonism. METHODS: Cross-sectional comparisons of 1 year of direct costs were done. Fifteen patients met criteria for DLB, and 133 met criteria for probable AD, of whom 39 had signs of parkinsonism and 94 did not. Patients' caregivers reported on the patient's use of health care services, receipt of unpaid care, and comorbid medical conditions. Severity of cognitive impairment and parkinsonism were determined during patient examinations. Costs were estimated by multiplying utilization data by a unit cost for each type of care. Costs were compared after adjustment for covariates using multiple regression equations. RESULTS: After adjusting for important covariates, patients with AD/P or DLB had significantly higher annual direct costs than patients with AD. The average adjusted increases in costs above the AD baseline costs were 7,119 dollars (AD/P) and 13,754 dollars (DLB) for formal direct costs and 7,394 dollars (AD/P) and 19,564 dollars (DLB) for total direct costs. Models for the entire sample estimated that a 1-point increase in a parkinsonism scale would result in an annual increase of 784 dollars in formal costs and 827 dollars in total costs of care. CONCLUSIONS: Patients with Alzheimer's disease and parkinsonism or dementia with Lewy bodies have significantly higher formal and total direct costs of care than patients with Alzheimer's disease. Signs of parkinsonism in patients with degenerative dementias are significant independent predictors of costs of care.

Murman DL, Chen Q, Powell MC, Kuo SB, Bradley CJ, Colenda CC. · Department of Neurology, Michigan State University, East Lansing 48824, USA. · Neurology. · Pubmed #12473759 No free full text.

Abstract: OBJECTIVE: To determine the incremental costs associated with behavioral symptoms in patients with AD. METHODS: A total of 128 patients with probable AD were enrolled into this study. Cognitive function and extrapyramidal features were assessed in patients with AD. Caregivers were interviewed to determine use of health care services, receipt of unpaid care, severity of behavioral symptoms (Neuropsychiatric Inventory [NPI]), and comorbid medical conditions in patients with AD. Healthcare utilization data were multiplied by unit costs to estimate direct formal costs. Unpaid caregiving hours were multiplied by an hourly wage to estimate direct informal costs. The annual incremental direct costs of additional behavioral symptoms were estimated with multiple regression equations. RESULTS: Annual, direct costs were significantly higher in patients with AD at or above the median score on the NPI (high NPI group), after adjusting for group differences in severity of cognitive impairment and comorbid conditions. Patients in the high NPI group had formal costs between US$3,162 and US$5,919 higher than the low NPI group and total direct costs between US$10,670 and US$16,141 higher, depending on the severity of cognitive impairments. Models for the entire sample estimated that a one-point increase in the NPI score would result in an annual increase of between US$247 and US$409 in total direct costs, depending on the value of unpaid caregiving. CONCLUSIONS: Behavioral symptoms in patients with AD significantly increase direct costs of care.

Murman DL, Chen Q, Colucci PM, Colenda CC, Gelb DJ, Liang J. · Department of Neurology and Ophthalmology, Michigan State University, E. Lansing, Michigan 48824, USA. · Am J Geriatr Psychiatry. · Pubmed #11994221 No free full text.

Abstract: The authors conducted a survey of healthcare utilization in three dementia syndromes to determine whether type of dementia influenced utilization or resulting direct costs. Patients with Alzheimer disease (n=131), dementia with parkinsonism (n=85), and Huntington disease (n=51) were identified from a registry and enrolled. Caregivers completed the mailed survey, and direct costs were estimated. The presence of dementia with parkinsonism resulted in significantly greater utilization of long-term care services and higher total direct costs. In all three groups, long-term care costs accounted for the majority of direct costs. Unique patterns of utilization and costs are seen in specific neurodegenerative dementias.

Van Someren EJ, Swaab DF, Colenda CC, Cohen W, McCall WV, Rosenquist PB. · Graduate School Neurosciences Amsterdam, Netherlands Institute for Brain Research, The Netherlands. · Chronobiol Int. · Pubmed #10442243 No free full text.

Abstract: Sleep-wake rhythm disturbances in patients with Alzheimer's disease (AD) make a strong demand on caregivers and are among the most important reasons for institutionalization. Several previous studies reported that the disturbances improve with increased environmental light, which, through the retinohypothalamic tract, activates the suprachiasmatic nucleus (SCN), the biological clock of the brain. The data of recently published positive and negative reports on the effect of bright light on actigraphically assessed rest-activity rhythms in demented elderly were reanalyzed using several statistical procedures. It was demonstrated that the light-induced improvement in coupling of the rest-activity rhythm to the environmental zeitgeber of bright light is better detected using nonparametric procedures. Cosinor, complex demodulation, and Lomb-Scargle periodogram-derived variables are much less sensitive to this effect because of the highly nonsinusoidal waveform of the rest-activity rhythm. Guidelines for analyses of actigraphic data are given to improve the sensitivity to treatment effects in future studies.