Aging Begins at 30

Dementia in a Nutshell

The diagnosis of Alzheimer's disease by experts is 85% correct when compared to autopsy findings, but it takes 5 hours spread over 3 visits and complex equipment. The Dutch investigators tested 64 family physicians (one quarter of all FPs in the area) on their ability to correctly diagnose Alzheimer's disease compared to local experts using sophisticated methods. The practice population was about 2,115 patients and involved 93 patients in a 16-month period that might be demented. They made a correct diagnosis in 80%. This validated the general practitioner's judgment and accuracy of diagnosis. Although using the approved Dutch guide to Alzheimer's disease diagnosis, they relied mainly on the presence of memory problems, their clinical picture or illness script, medical deductive reasoning, the patient's worsening orientation, behavioral changes and the deterioration in the activities of daily living (like eating, dressing and self care.) Most patients had had some evidence of sickness for 2 years. This they found better than a scale of formal questions. This involved 3.6 contacts, each lasting 10 to 15 minutes, and a home visit in 40%.

An early diagnosis is important for several reasons: to help the relatives understand the patient's changed behavior, to understand the progress of the disease over time and to prepare for that, and to identify patients who might benefit from treatment to delay the progress of the disease.

An examination of health care utilization and the cost of Alzheimer's disease (AD) was made at Mount Sinai Medical Center in New York because of dissatisfaction for a variety of reasons with previous studies. An analysis of the records of 1,366 AD patients was compared to 13,660 patients of the same age and gender who were free of dementia. All demented patients spent 4 extra days in hospital and 3 more days in the nursing home than those without this diagnosis. The cost was $3,800 higher for AD patients. If in addition to AD a significant other disease was also present such as diabetes without complications or complicated diabetes, heart attack or congestive heart failure, then the excess costs were respectively higher by $3,800, $11,535, $1,729 or $5,036 than in the matched controls. Patients with early AD who were treated with anti-Alzheimer's disease medicines such as tacrine, donapezil, rivasitgmine or galentamine cost $2,410 less than matched untreated patients without AD. The reasons for increased costs included lack of patient compliance with care, their predisposition to infections and greater difficulty in arranging post discharge care. Suggestions for reducing the cost of care include reduced hospital and nursing home stays, better specialized AD discharge planning and the education of caregivers.

The group in San Francisco studied the effect of nursing home placement on the mental and physical health of family caregivers. There were 117 patients who were placed in a nursing home compared to 152 AD patients who stayed with their families. Caregivers' health did not improve in the families where the AD patient was transferred to a nursing home. Female family caregivers and spouses showed greater health decline than did children and in-law children regardless of the severity or the gender of the Alzheimer's patient. About 14% of patients were with a spouse, 60% with a spouse and offspring, 3% with an offspring only and 6% with a nonrelative. Although the loss of the "instrumental" care may be a big help, the emotional or physical health of the caregiver did not improve.

Section Top | Title Page

See related Patient Topics Alzheimer's Disease, Brain and Nervous System, Dementia, Mental Health and Behavior or Seniors' Health.

See related Provider Topics Alzheimer's Disease, Brain and Nervous System, Dementia, Mental Health and Behavior or Seniors' Health.

All contents copyright © 1992-2004 the Author(s) and The University of Iowa. All rights reserved.

http://www.vh.org/adult/patient/internalmedicine/aba30/2002/dementia.html