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      Economic Analysis of Formal Care, Informal Care, and Productivity Losses in Primary Care Patients who Screened Positive for Dementia in Germany

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          Abstract

          The majority of people with dementia (PwD) live at home and require professional formal care and informal care that is generally provided by close relatives.

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          Dementia diagnosis in developing countries: a cross-cultural validation study.

          Martin Prince, Daisy Acosta, Helen FK Chiu … (2003)
          Research into dementia is needed in developing countries. Assessment of variations in disease frequency between regions might enhance our understanding of the disease, but methodological difficulties need to be addressed. We aimed to develop and test a culturally and educationally unbiased diagnostic instrument for dementia. In a multicentre study, the 10/66 Dementia Research Group interviewed 2885 people aged 60 years and older in 25 centres, most in Universities, in India, China and southeast Asia, Latin America and the Caribbean, and Africa. 729 had dementia and three groups were free of dementia: 702 had depression, 694 had high education (as defined by each centre), and 760 had low education (as defined by each centre). Local clinicians diagnosed dementia and depression. An interviewer, masked to dementia diagnosis, administered the geriatric mental state, the community screening instrument for dementia, and the modified Consortium to Establish a Registry of Alzheimer's Disease (CERAD) ten-word list-learning task. Each measure independently predicted a diagnosis of dementia. In an analysis of half the sample, an algorithm derived from all three measures gave better results than any individual measure. Applied to the other half of the sample, this algorithm identified 94% of dementia cases with false-positive rates of 15%, 3%, and 6% in the depression, high education, and low education groups, respectively. Our algorithm is a sound basis for culturally and educationally sensitive dementia diagnosis in clinical and population-based research, supported by translations of its constituent measures into most languages used in the developing world.
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            Underdiagnosis of dementia in primary care: variations in the observed prevalence and comparisons to the expected prevalence.

            Amanda Connolly, Ella Gaehl, Helen Martin … (2011)
            Dementia is a major and growing health problem. Diagnosis is an important step in the access to care, but many dementia patients remain undiagnosed. This study investigated the magnitude and variation in the difference between 'observed' and 'estimated' prevalence of dementia in general practices. We also explored practice characteristics associated with observed prevalence rates. Six Primary Care Trusts (PCTs) provided data on all general practices (N = 351) in their area in terms of number of doctors, patient list size, number of patients over 65 years of age, socio-economic deprivation status of practices and number of patients on dementia registers. The average observed prevalence overall of dementia amongst patients 65 years and over was 3.0% [95CI 2.8, 3.2]. The observed prevalence was 54.5% [95CI 49.2, 58.9] lower than the prevalence observed in the epidemiological studies in the UK. For an average size general practice (list size of 5269 patients) approximately 27 [95CI 22, 32] patients with dementia may remain undiagnosed. Statistically significant differences in prevalence rates were found between the different PCTs (Wald chi-square = 103.8 p < 0.001). The observed prevalence of dementia was significantly lower among practices run by one GP compared to multiple GPs (p = 0.003), and in more affluent areas (p < 0.001). Just under a half of the expected numbers of patients with dementia are recognised in GP dementia registers. The underdiagnosis of dementia varies with practice characteristics, socio-economic deprivation and between PCTs, which has implications for the local implementation of the National Dementia Strategy.
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              The Bayer Activities of Daily Living Scale (B-ADL)

              Ian Hindmarch, Hartmut Lehfeld, Perry de Jongh … (1998)
              The Bayer Activities of Daily Living Scale (B-ADL) has been developed on an international basis to assess deficits in the performance of everyday activities. The scale’s main target group is community dwelling patients who suffer mild cognitive impairment or mild-to-moderate dementia. It comprises 25 items and takes the form of a questionnaire to be completed by a caregiver or other informant sufficiently familiar with the patient. Statistical, clinical and domain-related criteria were used to select items from among a large number of activities of daily living (ADL) questions field tested in pilot studies in the USA, Germany, UK, Russia and Greece. The items included in the B-ADL have been chosen for their sensitivity to cognitive impairment, simplicity of concept, international applicability and their relevance to patients coping with the demands of everyday life. The scale uses items which reflect a wide range of domains. On account of its brevity, it is thought especially suitable for application within a GP and primary care context for both screening a patient’s ADL capacities as well as for documentation of treatment effects and the progress of dementia. This paper focuses on a description of the scale and its application.
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                Author and article information

                Journal
                Title: Journal of Alzheimer's Disease
                Abbreviated Title: JAD
                Publisher: IOS Press
                ISSN (Print): 13872877
                ISSN (Electronic): 18758908
                Publication date Created: November 27 2015
                Publication date (Print): November 27 2015
                Volume: 50
                Issue: 1
                Pages: 47-59
                Affiliations
                [1 ]German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
                [2 ]Department of General Business Administration and Health Care Management, Ernst Moritz Arndt University Greifswald, Greifswald, Germany
                [3 ]Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, Ernst-Moritz-Arndt-University Greifswald, Greifswald, Germany
                Article
                DOI: 10.3233/JAD-150600
                PubMed ID: 26639964
                SO-VID: c6946e44-6252-4d24-a019-2ed8cf836bac
                Copyright © © 2015
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