172 results on '"A Wimo"'
Search Results
2. Integrating a multimodal lifestyle intervention with medical food in prodromal Alzheimer’s disease: the MIND-ADmini randomized controlled trial
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Thunborg, Charlotta, Wang, Rui, Rosenberg, Anna, Sindi, Shireen, Andersen, Pia, Andrieu, Sandrine, Broersen, Laus M., Coley, Nicola, Couderc, Celine, Duval, Celine Z., Faxen-Irving, Gerd, Hagman, Göran, Hallikainen, Merja, Håkansson, Krister, Kekkonen, Eija, Lehtisalo, Jenni, Levak, Nicholas, Mangialasche, Francesca, Pantel, Johannes, Rydström, Anders, Stigsdotter-Neely, Anna, Wimo, Anders, Ngandu, Tiia, Soininen, Hilkka, Hartmann, Tobias, Solomon, Alina, and Kivipelto, Miia
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- 2024
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3. Integrating a multimodal lifestyle intervention with medical food in prodromal Alzheimer’s disease: the MIND-ADmini randomized controlled trial
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Charlotta Thunborg, Rui Wang, Anna Rosenberg, Shireen Sindi, Pia Andersen, Sandrine Andrieu, Laus M. Broersen, Nicola Coley, Celine Couderc, Celine Z. Duval, Gerd Faxen-Irving, Göran Hagman, Merja Hallikainen, Krister Håkansson, Eija Kekkonen, Jenni Lehtisalo, Nicholas Levak, Francesca Mangialasche, Johannes Pantel, Anders Rydström, Anna Stigsdotter-Neely, Anders Wimo, Tiia Ngandu, Hilkka Soininen, Tobias Hartmann, Alina Solomon, and Miia Kivipelto
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Alzheimer’s disease ,Lifestyle intervention ,Multimodal intervention ,Adherence ,Medical food ,Prevention ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Abstract Background The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) showed cognitive benefits from a multidomain lifestyle intervention in at-risk older people. The LipiDiDiet trial highlighted benefits of medical food in prodromal Alzheimer’s disease (AD). However, the feasibility and impact of multimodal interventions combining lifestyle with medical food in prodromal AD is unclear. Methods MIND-ADmini was a 6-month multinational (Sweden, Finland, Germany, France) proof-of-concept randomized controlled trial (RCT). Participants were 60–85 years old, had prodromal AD (International Working Group-1 criteria), and vascular/lifestyle risk factors. The parallel-group RCT had three arms: multimodal lifestyle intervention (nutritional guidance, exercise, cognitive training, vascular/metabolic risk management and social stimulation); multimodal lifestyle intervention + medical food (Fortasyn Connect); and regular health advice/care (control). Participants were randomized 1:1:1 (computer-generated allocation at each site). Outcome evaluators were blinded to randomization. Primary outcome was feasibility of the multimodal intervention, evaluated by recruitment rate during a 6-month recruitment phase, overall adherence in each intervention arm, and 6-month retention rate. Successful adherence was pre-specified as attending ≥ 40% of sessions/domain in ≥ 2/4 domains (lifestyle intervention), and consuming ≥ 60% of the medical food (lifestyle intervention + medical food). The secondary outcomes included adherence/participation to each intervention component and overall adherence to healthy lifestyle changes, measured using a composite score for healthy lifestyle. Cognitive assessments were included as exploratory outcomes, e.g. Clinical Dementia Rating scale. Results During September 2017-May 2019, 93 individuals were randomized (32 lifestyle intervention, 31 lifestyle + medical food, and 30 control group). Overall recruitment rate was 76.2% (64.8% during the first 6 months). Overall 6-month retention rate was 91.4% (lifestyle intervention 87.5%; lifestyle + medical food 90.3%; control 96.7%). Domain-specific adherence in the lifestyle intervention group was 71.9% to cognitive training, 78.1% exercise, 68.8% nutritional guidance, and 81.3% vascular risk management; and in the lifestyle + medical food group, 90.3% to cognitive training, 87.1% exercise, 80.7% nutritional guidance, 87.1% vascular risk management, and 87.1% medical food. Compared with control, both intervention arms showed healthy diet improvements (βLifestyle×Time = 1.11, P = 0.038; βLifestyle+medical food×Time = 1.43, P = 0.007); the lifestyle + medical food group also showed vascular risk reduction (P = 0.043) and less cognitive-functional decline (P
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- 2024
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4. Estimates of Current Capacity for Diagnosing Alzheimer’s Disease in Sweden and the Need to Expand Specialist Numbers
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Mattke, Soeren, Gustavsson, A., Jacobs, L., Kern, S., Palmqvist, S., Eriksdotter, M., Skoog, I., Winblad, B., Wimo, A., and Jönsson, L.
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- 2024
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5. Health-related quality of life in subjective cognitive decline and mild cognitive impairment: a longitudinal cohort analysis
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Aye, Sandar, Bouteloup, Vincent, Tate, Ashley, Wimo, Anders, Handels, Ron, Jean, Delphine, Winblad, Bengt, and Jönsson, Linus
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- 2023
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6. Changes in dementia diagnoses in Sweden during the COVID-19 pandemic
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Axenhus, Michael, Schedin-Weiss, Sophia, Tjernberg, Lars, Wimo, Anders, Eriksdotter, Maria, Bucht, Gustaf, and Winblad, Bengt
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- 2022
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7. Multimodal Preventive Trial for Alzheimer’s Disease: MIND-ADmini Pilot Trial Study Design and Progress
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Sindi, S., Thunborg, C., Rosenberg, A., Andersen, P., Andrieu, S., Broersen, L. M., Coley, N., Couderc, C., Duval, C. Z., Faxen-Irving, G., Hagman, G., Hallikainen, M., Håkansson, K., Lehtisalo, J., Levak, N., Mangialasche, F., Pantel, J., Kekkonen, E., Rydström, A., Stigsdotter-Neely, A., Wimo, A., Ngandu, T., Soininen, H., Hartmann, T., Solomon, A., and Kivipelto, Miia
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- 2022
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8. Costs of diagnosing early Alzheimer's disease in three European memory clinic settings: Results from the precision medicine in Alzheimer's disease project.
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Wimo, Anders, Kirsebom, Bjørn‐Eivind, Timón‐Reina, Santiago, Vromen, Ellen, Selnes, Per, Bon, Jaka, Emersic, Andreja, Kramberger, Milica Gregoric, Speh, Andreja, Visser, Pieter Jelle, Winblad, Bengt, and Fladby, Tormod
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ALZHEIMER'S disease diagnosis , *CEREBROSPINAL fluid examination , *COST effectiveness , *COGNITIVE testing , *RESEARCH funding , *MAGNETIC resonance imaging , *POSITRON emission tomography , *DESCRIPTIVE statistics , *APOLIPOPROTEINS , *EARLY diagnosis , *INDIVIDUALIZED medicine , *CONFIDENCE intervals , *MEDICAL care costs , *BIOMARKERS - Abstract
Objectives: The implementation of disease‐modifying treatments for Alzheimer's Disease (AD) will require cost‐effective diagnostic processes. As part of The Precision Medicine In AD consortium (PMI‐AD) project, the aim is to analyze the baseline costs of diagnosing early AD at memory clinics in Norway, Slovenia, and the Netherlands. Methods: The costs of cognitive testing and a clinical examination, apolipoprotein E, magnetic resonance imaging (MRI), cerebrospinal fluid (CSF), positron emission tomography and blood‐based biomarkers (BBM), which are used in different combinations in the three countries, were analyzed. Standardized unit costs, adjusted for GDP per capita and based on Swedish conditions were applied. The costs were expressed in euros (€) as of 2019. A diagnostic set comprising clinical examination, cognitive testing, MRI and CSF was defined as the gold standard, with MRI mainly used as an exclusion filter. Results: Cost data were available for 994 persons in Norway, 169 in Slovenia and 1015 in the Netherlands. The mean diagnostic costs were 1478 (95% confidence interval 1433–1523) € in Norway, 851 (731–970) € in Slovenia and 1184 (1135–1232) € in the Netherlands. Norway had the highest unit costs but also the greatest use of tests. With a uniform diagnostic test set applied, the diagnostic costs were 1264 (1238–1291) €, in Norway, 843 (771–914) € in Slovenia and 1184 (1156–1213) € in the Netherlands. There were no major cost differences between the final set of diagnoses. Conclusions: The total costs for setting a diagnosis of AD varied somewhat in the three countries, depending on unit costs and use of tests. These costs are relatively low in comparison to the societal costs of AD. Key points: The introduction of blood‐based biomarkers for detecting Alzheimer's Disease (AD) can change the diagnostic process.Given the expected demands for treatment of cognitive disorders such as AD, the costs and capacity of the diagnostic work‐up are of great importance for care funders and planners.Our study incorporating diagnostic costs from three distinct European regions provides valuable inputs for cost‐effectiveness studies. [ABSTRACT FROM AUTHOR]
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- 2024
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9. Slovenian Memory Clinic Organization with the Introduction of Potential New Alzheimer's Disease Treatment.
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Zupanic, Eva, Emersic, Andreja, Wimo, Anders, Winblad, Bengt, Speh, Andreja, and Kramberger, Milica Gregoric
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ALZHEIMER'S disease ,THERAPEUTICS ,LECANEMAB ,MILD cognitive impairment - Abstract
Slovenia, situated in Central Europe with a population of 2.1 million, has an estimated 44,278 individuals with mild cognitive impairment due to Alzheimer's disease or mild Alzheimer's dementia, rendering them potential candidates for disease-modifying treatment (DMT), such as lecanemab. We identified 114 potential candidates whose real-life expenses for diagnostic process surmount to more than €80,000. Treating all potential candidates nationwide would amount to €1.06 billion, surpassing Slovenia's entire annual medication expenditure for 2022 (€743 million). The introduction of DMTs and the associated logistics, along with potential complications, will significantly change societal, professional, and patient approach to treatment of Alzheimer's disease. [ABSTRACT FROM AUTHOR]
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- 2024
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10. Global and regional spending on dementia care from 2000–2019 and expected future health spending scenarios from 2020–2050: An economic modelling exercise
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Paola Pedroza Velandia, Molly K Miller-Petrie, Carina Chen, Suman Chakrabarti, Abigail Chapin, Simon Hay, Golsum Tsakalos, Anders Wimo, and Joseph L Dieleman
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Dementia ,Alzheimer's disease ,Health care spending ,Medicine (General) ,R5-920 - Abstract
Summary: Background: The global burden of dementia is increasing. As diagnosis and treatment rates increase and populations grow and age, additional diagnosed cases will present a challenge to healthcare systems globally. Even modelled estimates of the current and future healthcare spending attributable to dementia are valuable for decision makers and advocates to prepare for growing demand. Methods: We modelled healthcare spending attributable to dementia from 2000 to 2019 and expected estimated future spending from 2020 to 2050 under multiple scenarios. Data were from the Global Burden of Diseases 2019 study and from two systematic literature reviews. We used meta-regression to estimate the fraction of dementia spending that is attributable to dementia for those receiving nursing home-based care and for those receiving community-based care. We used spatiotemporal Gaussian process regression to account for data missingness and model diagnosis and treatment rates, nursing home-based care and community-based care rates, and unit costs for the many countries without their own underlying estimates. Projections of future spending estimate a baseline scenario from 2020 to 2050 based on ongoing growth. Alternative scenarios assessed faster growth rates for dementia diagnosis and treatment rates, nursing home-based care, and healthcare costs. All spending is reported in 2019 United States dollars or 2019 purchasing-power parity-adjusted dollars. Findings: Based on observed and modelled inputs, we estimated that global spending on dementia increased by 4.5% (95% uncertainty interval: 3.4–5.4%) annually from 2000 to 2019, reaching $263 billion (95% uncertainty interval [UI] $199– $333) attributable to dementia in 2019. We estimated total healthcare spending on patients with dementia was $594 billion (95% UI $457–$843). Under the baseline scenario, we estimated that attributable dementia spending will reach $1.6 trillion (95% UI $0.9–$2.6) by 2050. We project it will represent 11% (95% UI 6–18%) of all expected health spending, although it could be as high as 17% (95% UI 10–26%) under alternative scenarios. Interpretation: Health systems will experience increases in the burden of dementia in the near future. These modelled direct cost estimates, built from a relatively small set of data and linear time trends, highlight the magnitude of health system resources expected to be used to provide care and ensure sufficient and adequate resources for aging populations and their caretakers. More data are needed to corroborate these important trends.
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- 2022
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11. Cost-effectiveness models for Alzheimer's disease and related dementias
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Handels, R.L.H., Green, C., Gustavsson, A., Herring, W.L., Winblad, B., Wimo, A., Skoldunger, A., Karlsson, A., Anderson, R., Belger, M., Bruck, C., Espinosa, R., Hlavka, J.P., Jutkowitz, E., Lin, P.J., Mendez, M.L., Mar, J., Shewmaker, P., Spackman, E., Tafazzoli, A., Tysinger, B., Jonsson, L., IPECAD, Modeling, RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, Psychology 2, and Public Health
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model validation ,COMPLICATIONS ,TRANSPARENCY ,decision-analytic modeling ,economic evaluation ,Epidemiology ,IMPACT ,Health Policy ,MORTALITY ,EDUCATION ,Alzheimer's disease ,VALIDATION ,PREVALENCE ,Psychiatry and Mental health ,Cellular and Molecular Neuroscience ,Developmental Neuroscience ,SDG 3 - Good Health and Well-being ,ECONOMIC EVALUATIONS ,RA0421 Public health. Hygiene. Preventive Medicine ,Cross-comparison ,Dementia ,Neurology (clinical) ,HEALTH ,Geriatrics and Gerontology ,HOOD CHALLENGE - Abstract
INTRODUCTION: The credibility of model-based economic evaluations of Alzheimer's disease (AD) interventions is central to appropriate decision-making in a policy context. We report on the International PharmacoEconomic Collaboration on Alzheimer's Disease (IPECAD) Modeling Workshop Challenge.METHODS: Two common benchmark scenarios, for the hypothetical treatment of AD mild cognitive impairment (MCI) and mild dementia, were developed jointly by 29 participants. Model outcomes were summarized, and cross-comparisons were discussed during a structured workshop.RESULTS: A broad concordance was established among participants. Mean 10-year restricted survival and time in MCI in the control group ranged across 10 MCI models from 6.7 to 9.5 years and 3.4 to 5.6 years, respectively; and across 4 mild dementia models from 5.4 to 7.9 years (survival) and 1.5 to 4.2 years (mild dementia).DISCUSSION: The model comparison increased our understanding of methods, data used, and disease progression. We established a collaboration framework to assess cost-effectiveness outcomes, an important step toward transparent and credible AD models.
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- 2023
12. People get ready! A new generation of Alzheimer's therapies may require new ways to deliver and pay for healthcare.
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Wahlberg, Karin, Winblad, Bengt, Cole, Amanda, Herring, William L., Ramsberg, Joakim, Torontali, Ilona, Visser, Pieter‐Jelle, Wimo, Anders, Wollaert, Lieve, and Jönsson, Linus
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The development of disease‐modifying therapies (DMTs) for Alzheimer's disease (AD) has progressed over the last decade, and the first‐ever therapies with potential to slow the progression of disease are approved in the United States. AD DMTs could provide life‐changing opportunities for people living with this disease, as well as for their caregivers. They could also ease some of the immense societal and economic burden of dementia. However, AD DMTs also come with major challenges due to the large unmet medical need, high prevalence of AD, new costs related to diagnosis, treatment and monitoring, and uncertainty in the therapies' actual clinical value. This perspective article discusses, from the broad perspective of various health systems and stakeholders, how we can overcome these challenges and improve society's readiness for AD DMTs. We propose that innovative payment models such as performance‐based payments, in combination with learning healthcare systems, could be the way forward to enable timely patient access to treatments, improve accuracy of cost‐effectiveness evaluations and overcome budgetary barriers. Other important considerations include the need for identification of key drivers of patient value, the relevance of different economic perspectives (i.e. healthcare vs. societal) and ethical questions in terms of treatment eligibility criteria. [ABSTRACT FROM AUTHOR]
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- 2024
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13. Predicting sojourn times across dementia disease stages, institutionalization, and mortality.
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Tate, Ashley E, Bouteloup, Vincent, van Maurik, Ingrid S., Jean, Delphine, Mank, Arenda, Speh, Andreja, Boilet, Valerie, van Harten, Argonde, Eriksdotter, Maria, Wimo, Anders, Dufouil, Carole, van der Flier, Wiesje M., and Jönsson, Linus
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INTRODUCTION: Inferring the timeline from mild cognitive impairment (MCI) to severe dementia is pivotal for patients, clinicians, and researchers. Literature is sparse and often contains few patients. We aim to determine the time spent in MCI, mild‐, moderate‐, severe dementia, and institutionalization until death. METHODS: Multistate modeling with Cox regression was used to obtain the sojourn time. Covariates were age at baseline, sex, amyloid status, and Alzheimer's disease (AD) or other dementia diagnosis. The sample included a register (SveDem) and memory clinics (Amsterdam Dementia Cohort and Memento). RESULTS: Using 80,543 patients, the sojourn time from clinically identified MCI to death across all patient groups ranged from 6.20 (95% confidence interval [CI]: 5.57–6.98) to 10.08 (8.94–12.18) years. DISCUSSION: Generally, sojourn time was inversely associated with older age at baseline, males, and AD diagnosis. The results provide key estimates for researchers and clinicians to estimate prognosis. [ABSTRACT FROM AUTHOR]
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- 2024
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14. General practitioners’ attitude toward early and pre‐dementia diagnosis of AD in five European countries—A MOPEAD project survey
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Lena Sannemann, Theresa Müller, Lisa Waterink, Marissa Zwan, Anders Wimo, Erik Stomrud, Susana Pinó, Jordi Arrufat, Octavio Rodríguez‐Gomez, Alba Benaque, Jaka Bon, Daniel Ferreira, Gunilla Johansson, Amanda Dron, Annette Dumas, Jean Georges, Milica G Kramberger, Pieter Jelle Visser, Bengt Winblad, Laura Campo, Mercè Boada, Frank Jessen, and MOPEAD consortium
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Alzheimer's disease ,dementia ,early diagnosis ,general practitioners ,mild cognitive impairment ,primary care ,Neurology. Diseases of the nervous system ,RC346-429 ,Geriatrics ,RC952-954.6 - Abstract
Abstract Introduction General practitioners (GPs) play a key role in early identification of dementia, yet diagnosis is often missed or delayed in primary care. As part of the multinational Models of Patient Engagement for Alzheimer's Disease project, we assess GPs’ attitude toward early and pre‐dementia diagnosis of AD and explore barriers to early diagnosis. Methods Our survey covered general attitude toward early diagnosis, diagnostic procedures, resources, and opinion on present and future treatment options across five European countries. Results In total 343 GPs completed the survey; 74% of GPs indicated that an early diagnosis is valuable. There were country‐specific differences in GPs’ perceptions of reimbursement and time available for the patient. If a drug were available to slow down the progression of AD, 59% of the GPs would change their implementation of early diagnosis. Discussion Our findings provide insight into GPs’ attitudes by exploring differences in perception and management of early diagnosis.
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- 2021
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15. Determinants of time to institutionalisation and related healthcare and societal costs in a community-based cohort of patients with Alzheimer’s disease dementia
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Belger, Mark, Haro, Josep Maria, Reed, Catherine, Happich, Michael, Argimon, Josep Maria, Bruno, Giuseppe, Dodel, Richard, Jones, Roy W., Vellas, Bruno, and Wimo, Anders
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- 2019
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16. Costs of dementia in the Czech Republic
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Holmerová, Iva, Hort, Jakub, Rusina, Robert, Wimo, Anders, and Šteffl, Michal
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- 2017
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17. Precision medicine in neurodegeneration: the IHI-PROMINENT project.
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Tate, Ashley, Suárez-Calvet, Marc, Ekelund, Mats, Eriksson, Sven, Eriksdotter, Maria, Van Der Flier, Wiesje M., Georges, Jean, Kivipelto, Miia, Kramberger, Milica G., Lindgren, Peter, Gispert López, Juan Domingo, Lötjönen, Jyrki, Persson, Sofie, Pla, Sandra, Solomon, Alina, Thurfjell, Lennart, Wimo, Anders, Winblad, Bengt, and Jönsson, Linus
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INDIVIDUALIZED medicine ,ALZHEIMER'S disease ,DIGITAL technology ,CLINICAL decision support systems ,NEURODEGENERATION - Abstract
Neurodegenerative diseases are one of the most important contributors to morbidity and mortality in the elderly. In Europe, over 14 million people are currently living with dementia, at a cost of over 400 billion EUR annually. Recent advances in diagnostics and approval for new pharmaceutical treatments for Alzheimer's disease (AD), the most common etiology of dementia, heralds the beginning of precision medicine in this field. However, their implementation will challenge an already over-burdened healthcare systems. There is a need for innovative digital solutions that can drive the related clinical pathways and optimize and personalize care delivery. Public-private partnerships are ideal vehicles to tackle these challenges. Here we describe the Innovative Health Initiative (IHI) public-private partnership project PROMINENT that has been initiated by connecting leading dementia researchers, medical professionals, dementia patients and their care partners with the latest innovative health technologies using a precision medicine based digital platform. The project builds upon the knowledge and already implemented digital tools from several collaborative initiatives that address new models for early detection, diagnosis, and monitoring of AD and other neurodegenerative disorders. The project aims to provide support to improvement efforts to each aspect of the care pathway including diagnosis, prognosis, treatment, and data collection for real world evidence and cost effectiveness studies. Ultimately the PROMINENT project is expected to lead to cost-effective care and improved health outcomes. [ABSTRACT FROM AUTHOR]
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- 2023
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18. How to deal with missing longitudinal data in cost of illness analysis in Alzheimer’s disease—suggestions from the GERAS observational study
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Mark Belger, Josep Maria Haro, Catherine Reed, Michael Happich, Kristin Kahle-Wrobleski, Josep Maria Argimon, Giuseppe Bruno, Richard Dodel, Roy W Jones, Bruno Vellas, and Anders Wimo
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Alzheimer’s disease ,Cost of illness ,Missing data analysis ,Missing data mechanisms ,Multiple imputation ,Medicine (General) ,R5-920 - Abstract
Abstract Background Missing data are a common problem in prospective studies with a long follow-up, and the volume, pattern and reasons for missing data may be relevant when estimating the cost of illness. We aimed to evaluate the effects of different methods for dealing with missing longitudinal cost data and for costing caregiver time on total societal costs in Alzheimer’s disease (AD). Methods GERAS is an 18-month observational study of costs associated with AD. Total societal costs included patient health and social care costs, and caregiver health and informal care costs. Missing data were classified as missing completely at random (MCAR), missing at random (MAR) or missing not at random (MNAR). Simulation datasets were generated from baseline data with 10–40 % missing total cost data for each missing data mechanism. Datasets were also simulated to reflect the missing cost data pattern at 18 months using MAR and MNAR assumptions. Naïve and multiple imputation (MI) methods were applied to each dataset and results compared with complete GERAS 18-month cost data. Opportunity and replacement cost approaches were used for caregiver time, which was costed with and without supervision included and with time for working caregivers only being costed. Results Total costs were available for 99.4 % of 1497 patients at baseline. For MCAR datasets, naïve methods performed as well as MI methods. For MAR, MI methods performed better than naïve methods. All imputation approaches were poor for MNAR data. For all approaches, percentage bias increased with missing data volume. For datasets reflecting 18-month patterns, a combination of imputation methods provided more accurate cost estimates (e.g. bias: −1 % vs −6 % for single MI method), although different approaches to costing caregiver time had a greater impact on estimated costs (29–43 % increase over base case estimate). Conclusions Methods used to impute missing cost data in AD will impact on accuracy of cost estimates although varying approaches to costing informal caregiver time has the greatest impact on total costs. Tailoring imputation methods to the reason for missing data will further our understanding of the best analytical approach for studies involving cost outcomes.
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- 2016
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19. The worldwide costs of dementia in 2019
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Anders Wimo, Katrin Seeher, Rodrigo Cataldi, Eva Cyhlarova, Joseph L. Dielemann, Oskar Frisell, Maëlenn Guerchet, Linus Jönsson, Angeladine Kenne Malaha, Emma Nichols, Paola Pedroza, Martin Prince, Martin Knapp, Tarun Dua, Epidémiologie des Maladies Chroniques en zone tropicale (EpiMaCT), CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale (INSERM)-OmégaHealth (ΩHealth), Université de Limoges (UNILIM)-Université de Limoges (UNILIM), and King‘s College London
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HB Economic Theory ,Alzheimer's disease cost cost-of-illness study dementia economics informal care ,Epidemiology ,Health Policy ,economics ,Alzheimer's disease ,[SHS.ECO]Humanities and Social Sciences/Economics and Finance ,informal care ,Psychiatry and Mental health ,Cellular and Molecular Neuroscience ,Developmental Neuroscience ,Alzheimer s disease ,cost ,cost-of-illness study ,dementia ,RA0421 Public health. Hygiene. Preventive Medicine ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,Gerontologi, medicinsk/hälsovetenskaplig inriktning ,Neurology (clinical) ,Gerontology, specialising in Medical and Health Sciences ,Geriatrics and Gerontology - Abstract
Introduction: Dementia is a leading cause of death and disability globally. Estimating total societal costs demonstrates the wide impact of dementia and its main direct and indirect economic components. Methods: We constructed a global cost model for dementia, presenting costs as cumulated global and regional costs. Results: In 2019, the annual global societal costs of dementia were estimated at US $1313.4 billion for 55.2 million people with dementia, corresponding to US $23,796 per person with dementia. Of the total, US $213.2 billion (16%) were direct medical costs, US $448.7 billion (34%) direct social sector costs (including long-term care), and US $651.4 billion (50%) costs of informal care. Discussion: The huge costs of dementia worldwide place enormous strains on care systems and families alike. Although most people with dementia live in low- and middle-income countries, highest total and per-person costs are seen in high-income countries. Highlights: Global economic costs of dementia were estimated to reach US $1313.4 in 2019. Sixty-one percent of people with dementia live in low-and middle-income countries, whereas 74% of the costs occur in high-income countries. The impact of informal care accounts for about 50% of the global costs. The development of a long-term care infrastructure is a great challenge for low-and middle-income countries. There is a great need for more cost studies, particularly in low- and middle-income countries. Discussions of a framework for global cost comparisons are needed.
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- 2023
20. A Cost-Consequence Analysis of Different Screening Procedures in Alzheimer’s Disease: Results from the MOPEAD Project
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Wimo, Anders, Belger, Mark, Sannemann, Lena, Stoekenbroek, Malou, Gurruchaga Telleria, Miren, Valero, Sergi, Vermunt, Lisa, Waterink, Lisa, Winblad, Bengt, Visser, Peter Jelle, Zwan, Marissa, Boada, Mercè, Bon, Jaka, Collaborators, consortium, members of the MOPEAD, Escher, Claus, Müller, Theresa, Bogdanovic, Nenad, Andersen, Pia, Spulber, Gabriela, Sundström, Maria, Westman, Eric, Ferreira, Daniel, Jessen, Frank, Jelic, Vesna, Haglund, Anders, Stomrud, Erik, Nelvig, Anders, Saha, Samir, Petek, Davorina, Serné, Erik, Dumas, Annette, Kramberger, Milica G, Jamilis, Laura, Johansson, Gunilla, Rodrigo Salas, Adrián, Rodríguez Gómez, Octavio, Clinical chemistry, Neurology, and Amsterdam Neuroscience - Neurodegeneration
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medicine.medical_specialty ,Referral ,statistics & numerical data [Internet] ,Cost consequences ,diagnosis ,Cost-Benefit Analysis ,Population ,costs ,Primary care ,Disease ,cost analysis ,Alzheimer Disease ,Diabetes mellitus ,medicine ,Diabetes Mellitus ,Dementia ,Humans ,Mass Screening ,ddc:610 ,education ,Screening procedures ,education.field_of_study ,Internet ,Primary Health Care ,business.industry ,General Neuroscience ,economics [Primary Health Care] ,screening ,diagnosis [Alzheimer Disease] ,General Medicine ,medicine.disease ,Europe ,Psychiatry and Mental health ,Clinical Psychology ,Family medicine ,cost-consequence analysis ,statistics & numerical data [Primary Health Care] ,diagnostic work-up ,Geriatrics and Gerontology ,Patient Participation ,business ,economics [Internet] ,Alzheimer’s disease ,Research Article ,dementia - Abstract
Background: For care planning and support, under-detection and late diagnosis of Alzheimer’s disease (AD) is a great challenge. Models of Patient-Engagement for Alzheimer’s Disease (MOPEAD) is an EU-funded project aiming at testing different strategies to improve this situation. Objective: To make a cost-consequence analysis of MOPEAD. Methods: Four screening strategies were tested in five countries (Germany, the Netherlands, Slovenia, Spain, and Sweden): 1) a web-approach; 2) Open-House initiative; 3) in primary care; and 4) by diabetes specialists. Persons-at-risk of AD in all strategies were offered referral to a hospital-based specialist. The primary health-economic outcome was the cost per true-positive case (TP) of AD from the screened population. Results: Of 2,847 screened persons, 1,121 screened positive (39%), 402 were evaluated at memory clinics (14%), and 236 got an AD diagnosis (8%). The cost per TP of those screened was €3,115 with the web-approach, €2,722 with the Open-House, €1,530 in primary care, and €1,190 by diabetes specialists. Sensitivity analyses that more likely reflect the real-world situation confirmed the results. The number-needed-to-screen was 30 with the web-approach, 8 with the Open-House and primary care, and 6 with the diabetes specialists. There were country differences in terms of screening rates, referrals to memory clinics, staff-types involved, and costs per TP. Conclusion: In primary care and by the diabetes specialist, the costs per TP/screened population were lowest, but the capacity of such settings to identify cases with AD-risk must be discussed. Hence new diagnostic strategies such as web-solutions and Open-House initiatives may be valuable after modifications.
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- 2021
21. Caregiver Burden in Alzheimer's Disease: Differential Associations in Adult-Child and Spousal Caregivers in the GERAS Observational Study
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Catherine Reed, Mark Belger, Grazia Dell'Agnello, Anders Wimo, Josep Maria Argimon, Giuseppe Bruno, Richard Dodel, Josep Maria Haro, Roy W. Jones, and Bruno Vellas
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Adult-child caregiver ,Alzheimer’s disease ,Europe ,Observational study ,Spousal caregiver ,Neurology. Diseases of the nervous system ,RC346-429 ,Geriatrics ,RC952-954.6 - Abstract
Background/Aims: To examine factors influencing the caregiver burden in adult-child and spousal caregivers of community-dwelling patients with Alzheimer's disease (AD). Methods: Baseline data from the 18-month, prospective, observational GERAS study of 1,497 patients with AD in France, Germany, and the UK were used. Analyses were performed on two groups of caregivers: spouses (n = 985) and adult children (n = 405). General linear models estimated patient and caregiver factors associated with subjective caregiver burden assessed using the Zarit Burden Interview. Results: The caregiver burden increased with AD severity. Adult-child caregivers experienced a higher burden than spousal caregivers despite spending less time caring. Worse patient functional ability and more caregiver distress were independently associated with a greater burden in both adult-child and spousal caregivers. Additional factors were differentially associated with a greater caregiver burden in both groups. In adult-child caregivers these were: living with the patient, patient living in an urban location, and patient with a fall in the past 3 months; in spouses the factors were: caregiver gender (female) and age (younger), and more years of patient education. Conclusion: The perceived burden differed between adult-child and spousal caregivers, and specific patient and caregiver factors were differentially associated with this burden.
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- 2014
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22. Changes in dementia diagnoses in Sweden during the COVID-19 pandemic
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Michael Axenhus, Sophia Schedin-Weiss, Lars Tjernberg, Anders Wimo, Maria Eriksdotter, Gustaf Bucht, and Bengt Winblad
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Sweden ,Incidence ,Geriatrik ,COVID-19 ,Public Health, Global Health, Social Medicine and Epidemiology ,Vascular dementia ,Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi ,Geriatrics ,mental disorders ,Diagnosis ,Humans ,Female ,Dementia ,Geriatrics and Gerontology ,Pandemics ,Alzheimer’s disease ,Aged - Abstract
Introduction The COVID-19 pandemic has caused large disruptions to healthcare systems. Refocus on COVID-19 related care might have contributed to indirect effects on other healthcare areas. Care focused on acute conditions have been negatively affected although research into the effects on chronic and care intensive patient groups such as patients with dementia diseases is lacking. In this study we evaluated dementia diagnosis trends in Sweden during 2015–2020 according to International Classification of Disease version 10 coding of common dementia diseases. Methods Regional and national statistics in the form of International Classification of Disease version 10 coding, COVID-19 incidence, mortality data, and population census data were collected from the National Institute of Health and Welfare. Logistic regression analysis was performed to identify trends of dementia diagnosis during 2015–2020. Correlation test was performed between COVID-19 incidence, mortality rates, and dementia coding. Results Dementia diagnosis incidence has been declining since 2015 and further decline was noted in many regions in Sweden during 2020. As COVID-19 incidence increased, fewer cases of dementia were diagnosed, a decrease that differentially impacted women and those who were advanced in age. Conclusions Dementia diagnosis incidence in Sweden has been on a decline since 2015. The COVID-19 pandemic caused a further larger decline in dementia diagnosis incidence during 2020. COVID-19 incidence, but not mortality, was associated with decrease in dementia diagnosis incidence. There might be a large number of undiagnosed patients with dementia and healthcare reforms should be enacted to address this. Women and elderly are particularly vulnerable groups.
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- 2022
23. Analysis of burden in caregivers of people with Alzheimer’s disease using self-report and supervision hours
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Haro, J. M., Kahle-Wrobleski, Kristin, Bruno, G., Belger, M., Dell’Agnello, G., Dodel, R., Jones, R. W., Reed, C. C., Vellas, B., Wimo, A., and Argimon, J. M.
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- 2014
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24. The Costs of Dementia in Europe: An Updated Review and Meta-analysis.
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Jönsson, Linus, Tate, Ashley, Frisell, Oskar, and Wimo, Anders
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ALZHEIMER'S disease ,COST estimates ,ECONOMIC aspects of diseases ,DEMENTIA ,DISTRIBUTION costs ,APOLIPOPROTEIN E4 - Abstract
Background and Objective: The prevalence of dementia is increasing, while new opportunities for diagnosing, treating and possibly preventing Alzheimer's disease and other dementia disorders are placing focus on the need for accurate estimates of costs in dementia. Considerable methodological heterogeneity creates challenges for synthesising the existing literature. This study aimed to estimate the costs for persons with dementia in Europe, disaggregated into cost components and informative patient subgroups. Methods: We conducted an updated literature review searching PubMed, Embase and Web of Science for studies published from 2008 to July 2021 reporting empirically based cost estimates for persons with dementia in European countries. We excluded highly selective or otherwise biased reports, and used a random-effects meta-analysis to produce estimates of mean costs of care across five European regions. Results: Based on 113 studies from 17 European countries, the estimated mean costs for all patients by region were highest in the British Isles (73,712 EUR), followed by the Nordics (43,767 EUR), Southern (35,866 EUR), Western (38,249 EUR), and Eastern Europe and Baltics (7938 EUR). Costs increased with disease severity, and the distribution of costs over informal and formal care followed a North-South gradient with Southern Europe being most reliant on informal care. Conclusions: To our knowledge, this study represents the most extensive meta-analysis of the cost for persons with dementia in Europe to date. Though there is considerable heterogeneity across studies, much of this is explained by identifiable factors. Further standardisation of methodology for capturing resource utilisation data may further improve comparability of future studies. The cost estimates presented here may be of value for cost-of-illness studies and economic evaluations of novel diagnostic technologies and therapies for Alzheimer's disease. [ABSTRACT FROM AUTHOR]
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- 2023
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25. Factors associated with long-term impact on informal caregivers during Alzheimer’s disease dementia progression: 36-month results from GERAS
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J. Scott Andrews, Roy W. Jones, Mark Belger, Catherine Reed, Richard Dodel, Josep Maria Haro, Antje Tockhorn-Heidenreich, and Anders Wimo
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Male ,Gerontology ,Longitudinal study ,Time Factors ,Medizin ,Psychological intervention ,Investigació mèdica ,Behavioral Symptoms ,Affect (psychology) ,Severity of Illness Index ,Cost of Illness ,Medicine research ,Alzheimer Disease ,Germany ,Activities of Daily Living ,Humans ,Medicine ,Dementia ,Cognitive Dysfunction ,Longitudinal Studies ,Prospective Studies ,Cognitive decline ,Aged ,Aged, 80 and over ,business.industry ,Repeated measures design ,Cuidadors ,Caregiver burden ,Middle Aged ,Alzheimer's disease ,Mental Status and Dementia Tests ,medicine.disease ,Psychiatry and Mental health ,Clinical Psychology ,Malaltia d'Alzheimer ,Caregivers ,Disease Progression ,Linear Models ,Female ,Observational study ,France ,Independent Living ,Geriatrics and Gerontology ,business - Abstract
Objective:To identify, in caregivers of patients with Alzheimer’s disease (AD) dementia, factors associated with subjective (personal, physical, emotional, and social) and objective (informal caregiver time and costs) caregiver burden.Design:Prospective longitudinal European observational study: post-hoc analysis.Setting:Clinic.Participants:Community-dwelling patients in France and Germany aged ≥ 55 years (n = 969) with probable AD and their informal caregivers.Measurements:Mini-Mental State Examination (MMSE), Alzheimer’s Disease Cooperative Study—Activities of Daily Living (ADCS-ADL), 12-item Neuropsychiatric Inventory (NPI-12), Zarit Burden Interview (ZBI), informal caregiver basic and instrumental ADL hours (Resource Utilization in Dementia instrument), and informal caregiver costs. Mixed-effect models of repeated measures (MMRM) were run, including baseline and time-dependent covariates (change from baseline [CFB] to 18 months in MMSE, ADCS-ADL, and NPI-12 scores) associated with CFB in ZBI score/informal caregiver time over 36 months (analyzed using linear regression models) and informal caregiver costs over 36 months (analyzed using generalized linear models).Results:Greater decline in patient function (ADCS-ADL) over 18 months was associated with increased subjective caregiver burden (ZBI), hours, and costs over 36 months. Increased behavioral problems (NPI-12) over 18 months also negatively impacted ZBI. Cognitive decline (MMSE) over 18 months did not affect change in caregiver burden.Conclusions:Long-term informal caregiver burden was driven by worsening functional abilities and behavioral symptoms but not cognitive decline, over 18 months in community-dwelling patients with AD dementia. Identifying the drivers of caregiver burden could highlight areas in which interventions may benefit both caregivers and patients.
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- 2019
26. Changes in mortality trends amongst common diseases during the COVID-19 pandemic in Sweden.
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Axenhus, Michael, Schedin-Weiss, Sophia, Winblad, Bengt, and Wimo, Anders
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CARDIOVASCULAR disease related mortality ,NOSOLOGY ,NEUROLOGICAL disorders ,COMMUNICABLE diseases ,MORTALITY ,DISEASES ,REGRESSION analysis ,TUMORS ,COVID-19 pandemic - Abstract
Objective: It has been found that COVID-19 increases deaths within common diseases in countries that have implemented strict lockdowns. In order to elucidate the proper national response to a pandemic, the mortality rates within COVID-19 and various diseases need to be studied in countries whose pandemic response differ. Sweden represents a country with lax pandemic restrictions, and we aimed to study the effects of COVID-19 on historical mortality rates within common diseases during 2020. Methods: Regression models and moving averages were used to predict expected premature mortality per the ICD-10 during 2020 using historical data sets. Predicted values were then compared to recorded premature mortality to identify changes in mortality trends. Results: Seasonal increased mortality was found within neurological diseases. Infectious diseases, tumours and cardiac disease mortality rates decreased compared to expected outcome. Conclusions: Changes in mortality trends were observed for several common diseases during the COVID-19 pandemic. Neurological and cardiac conditions, infections and tumours are examples of diseases that were heavily affected by the pandemic. The indirect effects of COVID-19 on certain patient populations should be considered when determining pandemic impact. [ABSTRACT FROM AUTHOR]
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- 2022
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27. General practitioners' attitude toward early and pre-dementia diagnosis of AD in five European countries-A MOPEAD project survey
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Frank Jessen, Pieter Jelle Visser, Erik Stomrud, Jaka Bon, Octavio Rodriguez-Gomez, Theresa Müller, Amanda Dron, Bengt Winblad, Susana Pinó, Laura Campo, Mercè Boada, Jean Georges, Lena Sannemann, Alba Benaque, Jordi Arrufat, Gunilla Johansson, Milica G. Kramberger, Anders Wimo, Marissa D. Zwan, Lisa Waterink, Annette Dumas, Daniel Ferreira, Neurology, Amsterdam Neuroscience - Neurodegeneration, RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, and Psychiatrie & Neuropsychologie
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medicine.medical_specialty ,PRIMARY-CARE PHYSICIANS ,media_common.quotation_subject ,Disease ,Primary care ,Alzheimer&apos ,s disease ,03 medical and health sciences ,primary care ,0302 clinical medicine ,mild cognitive impairment ,general practitioners ,Perception ,medicine ,MANAGEMENT ,Dementia ,Dementia diagnosis ,KNOWLEDGE ,ddc:610 ,RC346-429 ,Reimbursement ,030304 developmental biology ,media_common ,Diagnostic Assessment & Prognosis ,0303 health sciences ,business.industry ,RC952-954.6 ,Treatment options ,Alzheimer's disease ,medicine.disease ,ALZHEIMERS-DISEASE ,Psychiatry and Mental health ,Geriatrics ,Family medicine ,Global Positioning System ,Neurology (clinical) ,Neurology. Diseases of the nervous system ,business ,030217 neurology & neurosurgery ,Research Article ,dementia ,early diagnosis - Abstract
Introduction: General practitioners (GPs) play a key role in early identification of dementia, yet diagnosis is often missed or delayed in primary care. As part of the multinational Models of Patient Engagement for Alzheimer’s Disease project, we assess GPs’ attitude toward early and pre-dementia diagnosis of AD and explore barriers to early diagnosis. Methods: Our survey covered general attitude toward early diagnosis, diagnostic procedures, resources, and opinion on present and future treatment options across five European countries. Results: In total 343 GPs completed the survey; 74% of GPs indicated that an early diagnosis is valuable. There were country-specific differences in GPs’ perceptions of reimbursement and time available for the patient. If a drug were available to slow down the progression of AD, 59% of the GPs would change their implementation of early diagnosis. Discussion: Our findings provide insight into GPs’ attitudes by exploring differences in perception and management of early diagnosis. (Less)
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- 2021
28. The resource utilization in dementia (RUD) instrument is valid for assessing informal care time in community-living patients with dementia
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Wimo, A., Jonsson, L., and Zbrozek, A.
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- 2010
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29. Caregiver Time and Cost of Home Care for Alzheimer’s Disease: A Clinic-based Observational Study in Beijing, China
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Wang, Huali, Gao, Tianfei, Wimo, Anders, and Yu, Xin
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- 2010
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30. Complementary pre‐screening strategies to uncover hidden prodromal and mild Alzheimer's disease: Results from the MOPEAD project.
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Boada, Mercè, Rodrigo, Adrián, Jessen, Frank, Wimblad, Bengt, Kramberger, Milica G., Visser, Pieter Jelle, Simó, Rafael, Rodríguez‐Gomez, Octavio, Ciudin, Andreea, Georges, Jean, Dumas, Annete, Maguire, Peggy, Krivec, David, Wimo, Anders, Valero, Sergi, Alegret, Montserrat, Jamilis, Laura, Zwan, Marissa, Sannemann, Lena, and Arrufat, Jordi
- Abstract
Introduction: The Models of Patient Engagement for Alzheimer's Disease (MOPEAD) project was conceived to explore innovative complementary strategies to uncover hidden prodromal and mild Alzheimer's disease (AD) dementia cases and to raise awareness both in the general public and among health professionals about the importance of early diagnosis. Methods: Four different strategies or RUNs were used: (a) a web‐based (WB) prescreening tool, (2) an open house initiative (OHI), (3) a primary care–based protocol for early detection of cognitive decline (PC), and (4) a tertiary care–based pre‐screening at diabetologist clinics (DC). Results: A total of 1129 patients at high risk of having prodromal AD or dementia were identified of 2847 pre‐screened individuals (39.7%). The corresponding proportion for the different initiatives were 36.8% (WB), 35.6% (OHI), 44.4% (PC), and 58.3% (DC). Conclusion: These four complementary pre‐screening strategies were useful for identifying individuals at high risk of having prodromal or mild AD. [ABSTRACT FROM AUTHOR]
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- 2022
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31. Quantifying and Describing the Natural History and Costs of Alzheimer's Disease and Effects of Hypothetical Interventions
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Wimo, Anders, Handels, Ron, Winblad, Bengt, Black, Christopher M., Johansson, Gunilla, Salomonsson, Stina, Eriksdotter, Maria, Khandker, Rezaul K., Psychiatrie & Neuropsychologie, and RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience
- Subjects
NATIONAL INSTITUTE ,MILD COGNITIVE IMPAIRMENT ,Neurologi ,IMPACT ,Cost-Benefit Analysis ,MODIFYING TREATMENT ,costs ,RECOMMENDATIONS ,Alzheimer Disease ,cost analysis ,mental disorders ,Humans ,Registries ,health care economics and organizations ,cost effectiveness ,DEMENTIA ,disease-modifying treatment ,Health Care Costs ,economics ,Alzheimer's disease ,Markov Chains ,PREVALENCE ,DEFINITION ,Neurology ,Disease Progression ,DIAGNOSTIC GUIDELINES ,Erratum ,ASSOCIATION WORKGROUPS ,Alzheimer’s disease ,Research Article ,dementia - Abstract
Background: A long-term horizon is necessary when the socioeconomic consequences and the potential effects of interventions in Alzheimer’s disease (AD) are estimated. Objectives: To illustrate the potential societal costs of AD across the disease continuum and to illustrate the potential cost-effectiveness of a hypothetical intervention with disease modifying treatment (DMT). Methods: Based on the Swedish dementia registry, a Markov model was used to simulate a virtual cohort of 100,000 people with mild cognitive impairment (MCI) due to AD (AD-MCI) in Sweden for 40 years starting at the age of 60. A simulated hypothetical intervention assumed a 25% reduction in progression rate during AD-MCI and mild AD-dementia. A comprehensive set of sensitivity analyses was included. Results: The cumulative risk to develop dementia was 96%. The mean simulated survival was 19.0 years. The net present value for a person year with dementia was 252,843 SEK (about 29,500 US$). The cost effectiveness model illustrated how the hypothetical scenario of a 25% reduction in progression to AD-dementia would require 41 AD-MCI patients to be treated to prevent one case of AD-dementia (2,447 avoided AD-dementia cases of 100,000 with AD-MCI). Most scenarios illustrated hypothetical cost effectiveness (based on a willingness to pay level of 600,000 SEK (70,000 US$) per gained QALY), but not cost savings. Discussion: Lifetime societal costs of AD are substantial. A future DMT may be potentially cost-effective given assumed treatment effects and costs, but cost savings are unlikely.
- Published
- 2020
32. Cost-Utility of Using Alzheimer’s Disease Biomarkers in Cerebrospinal Fluid to Predict Progression from Mild Cognitive Impairment to Dementia
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Ron Handels, Frans R.J. Verhey, Richard Dodel, Milica G. Kramberger, Pieter Jelle Visser, Anders Wimo, Bengt Winblad, José Luis Molinuevo, RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, Psychiatrie & Neuropsychologie, MUMC+: MA Med Staf Spec Psychiatrie (9), Neurology, and Amsterdam Neuroscience - Neurodegeneration
- Subjects
Male ,NATIONAL INSTITUTE ,economic evaluation ,IMPACT ,Cost-Benefit Analysis ,Social Stigma ,Medizin ,MODIFYING TREATMENT ,Disease ,RECOMMENDATIONS ,0302 clinical medicine ,Cerebrospinal fluid ,CRITERIA ,030212 general & internal medicine ,Cognitive impairment ,False Negative Reactions ,risk ,Aged, 80 and over ,General Neuroscience ,Uncertainty ,General Medicine ,Middle Aged ,Alzheimer's disease ,Psychiatry and Mental health ,Clinical Psychology ,Current practice ,Disease Progression ,Female ,Quality-Adjusted Life Years ,ASSOCIATION WORKGROUPS ,Adult ,medicine.medical_specialty ,cerebrospinal fluid ,03 medical and health sciences ,mild cognitive impairment ,Alzheimer Disease ,medicine ,Humans ,Dementia ,Cognitive Dysfunction ,Computer Simulation ,False Positive Reactions ,cost-utility ,Intensive care medicine ,Aged ,business.industry ,Alzheimer's disease biomarkers ,Models, Theoretical ,medicine.disease ,Cost utility ,Csf biomarkers ,DIAGNOSTIC GUIDELINES ,prognosis ,Geriatrics and Gerontology ,business ,Biomarkers ,030217 neurology & neurosurgery - Abstract
Background: Diagnostic research criteria for Alzheimer's disease support the use of biomarkers in the cerebrospinal fluid (CSF) to improve the accuracy of the prognosis regarding progression to dementia for people with mild cognitive impairment (MCI).Objective: The aim of this study was to estimate the potential incremental cost-effectiveness ratio of adding CSF biomarker testing to the standard diagnostic workup to determine the prognosis for patients with MCI.Methods: In an early technology assessment, a mathematical simulation model was built, using available evidence on added prognostic value as well as expert opinion to estimate the incremental costs and quality-adjusted life years (QALYs) of 20,000 virtual MCI patients with (intervention strategy) and without (control strategy) relying on CSF, from a health-care sector perspective and with a 5-year time horizon.Results: Adding the CSF test improved the accuracy of prognosis by 11%. This resulted in an average QALY gain of 0.046 and (sic)432 additional costs per patient, representing an incremental cost-effectiveness ratio of (sic)9,416.Conclusion: The results show the potential of CSF biomarkers in current practice from a health-economics perspective. This result was, however, marked by a high degree of uncertainty, and empirical research is required into the impact of a prognosis on worrying, false-positive/negative prognosis, and stigmatization.
- Published
- 2017
33. Disease Progression in Mild Dementia due to Alzheimer Disease in an 18-Month Observational Study (GERAS): The Impact on Costs and Caregiver Outcomes
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Anders Wimo, Grazia Dell'Agnello, Richard Dodel, Jeremie Lebrec, Kristin Kahle-Wrobleski, Josep Maria Haro, Giuseppe Bruno, Catherine Reed, Roy W. Jones, Bruno Vellas, and Josep Maria Argimon
- Subjects
medicine.medical_specialty ,Activities of daily living ,Cognitive Neuroscience ,lcsh:Geriatrics ,lcsh:RC346-429 ,Outcome assessment (health care) ,03 medical and health sciences ,0302 clinical medicine ,Cognition ,Medicine ,Dementia ,Original Research Article ,030212 general & internal medicine ,Functional decline ,Psychiatry ,lcsh:Neurology. Diseases of the nervous system ,Alzheimer disease ,Caregivers ,Disease progression ,Health care costs ,Health resources ,Psychiatry and Mental Health ,business.industry ,medicine.disease ,Psychiatry and Mental health ,lcsh:RC952-954.6 ,Mild dementia ,Observational study ,Alzheimer's disease ,business ,030217 neurology & neurosurgery - Abstract
Background/Aims: We assessed whether cognitive and functional decline in community-dwelling patients with mild Alzheimer disease (AD) dementia were associated with increased societal costs and caregiver burden and time outcomes. Methods: Cognitive decline was defined as a ≥3-point reduction in the Mini-Mental State Examination and functional decline as a decrease in the ability to perform one or more basic items of the Alzheimer’s Disease Cooperative Study Activities of Daily Living Inventory (ADCS-ADL) or ≥20% of instrumental ADL items. Total societal costs were estimated from resource use and caregiver hours using 2010 costs. Caregiver burden was assessed using the Zarit Burden Interview (ZBI); caregiver supervision and total hours were collected. Results: Of 566 patients with mild AD enrolled in the GERAS study, 494 were suitable for the current analysis. Mean monthly total societal costs were greater for patients showing functional (+61%) or cognitive decline (+27%) compared with those without decline. In relation to a typical mean monthly cost of approximately EUR 1,400 at baseline, this translated into increases over 18 months to EUR 2,254 and 1,778 for patients with functional and cognitive decline, respectively. The number of patients requiring supervision doubled among patients showing functional or cognitive decline compared with those not showing decline, while caregiver total time increased by 70 and 33%, respectively and ZBI total score by 5.3 and 3.4 points, respectively. Conclusion: Cognitive and, more notably, functional decline were associated with increases in costs and caregiver outcomes in patients with mild AD dementia.
- Published
- 2017
34. Assessing cost-effectiveness of early intervention in Alzheimer's disease: An open-source modeling framework
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Anders Gustavsson, Anders Sköldunger, Ron Handels, Colin Green, Bengt Winblad, Anders Wimo, Linus Jönsson, Psychiatrie & Neuropsychologie, and RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience
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Gerontology ,Male ,NATIONAL INSTITUTE ,MILD COGNITIVE IMPAIRMENT ,Epidemiology ,Cost effectiveness ,Cost-Benefit Analysis ,Ordered probit ,Disease ,ECONOMIC-EVALUATION ,RECOMMENDATIONS ,03 medical and health sciences ,Cellular and Molecular Neuroscience ,0302 clinical medicine ,Developmental Neuroscience ,Alzheimer Disease ,medicine ,Dementia ,Humans ,Decision-analytic modeling ,Cognitive Dysfunction ,030212 general & internal medicine ,Health policy ,Aged ,Models, Statistical ,Progression ,Cost-effectiveness analysis ,DEMENTIA ,MORTALITY ,Alzheimer's disease ,CARE ,medicine.disease ,Psychiatry and Mental health ,Early Diagnosis ,Economic evaluation ,Life expectancy ,Disease Progression ,Female ,DIAGNOSTIC GUIDELINES ,Neurology (clinical) ,Geriatrics and Gerontology ,Psychology ,Prediction ,ASSOCIATION WORKGROUPS ,030217 neurology & neurosurgery - Abstract
Introduction: We develop a framework to model disease progression across Alzheimer's disease (AD) and to assess the cost-effectiveness of future disease-modifying therapies (DMTs) for people with mild cognitive impairment (MCI) due to AD.Methods: Using data from the US National Alzheimer's Coordinating Center, we apply survival analysis to estimate transition from predementia to AD dementia and ordered probit regression to estimate transitions across AD dementia stages. We investigate the cost-effectiveness of a hypothetical treatment scenario for people in MCI due to AD.Results: We present an open-access model-based decision-analytic framework. Assuming a modest DMT treatment effect in MCI, we predict extended life expectancy and a reduction in time with AD dementia.Discussion: Any future DMT for AD is expected to pose significant economic challenges across all health-care systems, and decision-analytic modeling will be required to assess costs and outcomes. Further developments are needed to inform these health policy considerations. (C) 2019 The Authors. Published by Elsevier Inc. on behalf of the Alzheimer's Association.
- Published
- 2019
35. Determinants of time to institutionalisation and related healthcare and societal costs in a community-based cohort of patients with Alzheimer's disease dementia
- Author
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Mark Belger, Catherine Reed, Michael Happich, Bruno Vellas, Roy W. Jones, Josep Maria Argimon, Josep Maria Haro, Anders Wimo, Richard Dodel, and Giuseppe Bruno
- Subjects
Gerontology ,Male ,Activities of daily living ,Neurologi ,Economics, Econometrics and Finance (miscellaneous) ,Medizin ,Comorbidity ,Severity of Illness Index ,Cohort Studies ,Societal costs ,0302 clinical medicine ,Cost of Illness ,Health care ,030212 general & internal medicine ,Prospective Studies ,I00 (Health Education and Welfare: General) ,Aged, 80 and over ,Likelihood Functions ,Public health ,030503 health policy & services ,Health Policy ,Malalties neurodegeneratives ,Institutionalization ,Neurodegenerative Diseases ,Health Care Costs ,Alzheimer's disease ,Europe ,Caregivers ,Neurology ,Cohort ,Costs and Cost Analysis ,Female ,Independent Living ,0305 other medical science ,Alzheimer’s disease ,Cohort study ,medicine.medical_specialty ,Institutionalisation ,03 medical and health sciences ,Alzheimer Disease ,medicine ,Dementia ,Humans ,Caregiver ,Predictors ,2001 ,Aged ,Original Paper ,Health economics ,business.industry ,medicine.disease ,Salut pública ,I10 (Health: General) ,Malaltia d'Alzheimer ,I19 (Health: Other) ,business - Abstract
Objectives To examine the costs of caring for community-dwelling patients with Alzheimer’s disease (AD) dementia in relation to the time to institutionalisation. Methods GERAS was a prospective, non-interventional cohort study in community-dwelling patients with AD dementia and their caregivers in three European countries. Using identified factors associated with time to institutionalisation, models were developed to estimate the time to institutionalisation for all patients. Estimates of monthly total societal costs, patient healthcare costs and total patient costs (healthcare and social care together) prior to institutionalisation were developed as a function of the time to institutionalisation. Results Of the 1495 patients assessed at baseline, 307 (20.5%) were institutionalised over 36 months. Disease severity at baseline [based on Mini-Mental State Examination (MMSE) scores] was associated with risk of being institutionalised during follow up (p
- Published
- 2019
36. Early cost‐utility analysis of general and cerebrospinal fluid‐specific Alzheimer's disease biomarkers for hypothetical disease‐modifying treatment decision in mild cognitive impairment
- Author
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Manuela A. Joore, An Tran-Duy, Ron Handels, Claire A. G. Wolfs, Johan L. Severens, Frans R.J. Verhey, Anders Wimo, Health Technology Assessment (HTA), Psychiatrie & Neuropsychologie, Health Services Research, MUMC+: KIO Kemta (9), Interne Geneeskunde, RS: CAPHRI School for Public Health and Primary Care, RS: CAPHRI - R2 - Creating Value-Based Health Care, RS: CAPHRI - R3 - Functioning, Participating and Rehabilitation, and RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience
- Subjects
Male ,Oncology ,IMPACT ,Epidemiology ,Cost-Benefit Analysis ,Disease ,ECONOMIC-EVALUATION ,Cohort Studies ,Outcome Assessment, Health Care ,Non-U.S. Gov't ,Aged, 80 and over ,Cost-utility ,education.field_of_study ,Research Support, Non-U.S. Gov't ,DEMENTIA ,Health Policy ,Alzheimer's disease ,Psychiatry and Mental health ,Cerebrospinal fluid ,TESTS ,Biomarker (medicine) ,Female ,Psychology ,medicine.medical_specialty ,Decision analytic modeling ,MEDLINE ,Population ,Clinical Neurology ,Research Support ,DIAGNOSIS ,Community Health Planning ,Cellular and Molecular Neuroscience ,Developmental Neuroscience ,Alzheimer Disease ,Internal medicine ,Journal Article ,medicine ,Humans ,Dementia ,Psychiatry ,education ,Aged ,Cost–utility analysis ,Models, Statistical ,Hypothetical disease-modifying treatment ,Mild cognitive impairment ,Alzheimer's disease biomarkers ,Biomarker ,medicine.disease ,Economic evaluation ,Quality-adjusted life year ,Neurology (clinical) ,Geriatrics and Gerontology ,Cognition Disorders - Abstract
Introduction: The study aimed to determine the room for improvement of a perfect cerebrospinal fluid (CSF) biomarker and the societal incremental net monetary benefit of CSF in subjects with mild cognitive impairment (MCI) assuming a hypothetical disease-modifying Alzheimer's disease (AD) treatment.Methods: A decision model compared current practice to a perfect biomarker and to two strategies positioning CSF as add- on test when current practice concluded the presence or absence of AD.Results: The simulated MCI population was aged on average 68.3 and 49% had AD. The room for improvement by the perfect CSF test was 0.39 quality adjusted life years, V33,622 ($ 43,372) savings, 2.0 potential beneficial treatment years, and 1.3-year delay in dementia conversion.Discussion: The results indicated more potential benefit from a biomarker positioned to verify subjects who are not expected to have AD (i.e., to prevent undertreatment) rather than to verify subjects expected to have AD (prevent overtreatment). Sensitivity analyses explored different CSF positions. (C) 2015 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved.
- Published
- 2015
37. General practitioners’ attitude toward early and pre-dementia diagnosis of AD in five European countries—A MOPEAD project survey.
- Author
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Sannemann, Lena, Müller, Theresa, Waterink, Lisa, Zwan, Marissa, Wimo, Anders, Stomrud, Erik, Pinó, Susana, Arrufat, Jordi, Rodríguez-Gomez, Octavio, Benaque, Alba, Bon, Jaka, Ferreira, Daniel, Johansson, Gunilla, Dron, Amanda, Dumas, Annette, Georges, Jean, Kramberger, Milica G., Visser, Pieter Jelle, Winblad, Bengt, and Campo, Laura
- Subjects
EARLY diagnosis ,DEMENTIA ,PRIMARY care ,GENERAL practitioners ,ALZHEIMER'S disease ,MILD cognitive impairment - Abstract
Introduction: General practitioners (GPs) play a key role in early identification of dementia, yet diagnosis is often missed or delayed in primary care. As part of the multinational Models of Patient Engagement for Alzheimer’s Disease project, weassess GPs’attitude toward early and pre-dementia diagnosis of AD and explore barriers to early diagnosis. Methods: Our survey covered general attitude toward early diagnosis, diagnostic procedures, resources, and opinion on present and future treatment options across five European countries. Results: In total 343 GPs completed the survey; 74% of GPs indicated that an early diagnosis is valuable. There were country-specific differences in GPs’ perceptions of reimbursement and time available for the patient. If a drug were available to slow down the progression of AD, 59% of the GPs would change their implementation of early diagnosis. Discussion: Our findings provide insight into GPs’ attitudes by exploring differences in perception and management of early diagnosis. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
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38. How useful is the EQ-5D in assessing the impact of caring for people with Alzheimer's disease?
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Reed C, Barrett A, Lebrec J, Dodel R, Jones RW, Vellas B, Wimo A, Argimon JM, Bruno G, and Haro JM
- Subjects
Europe ,Health-related quality of life ,Observational study ,Caregiver burden ,Alzheimer’s disease ,Informal care - Abstract
BACKGROUND: The impact on informal caregivers of caring for people with Alzheimer's disease (AD) dementia can be substantial, but it remains unclear which measures(s) best assess such impact. Our objective was to use data from the GERAS study to assess the ability of the EuroQol 5-dimension questionnaire (EQ-5D) to measure the impact on caregivers of caring for people with AD dementia and to examine correlations between EQ-5D and caregiver burden. METHODS: GERAS was a prospective, non-interventional cohort study in community-dwelling patients with AD dementia and their informal caregivers. The EQ-5D and Zarit Burden Interview (ZBI) were used to measure health-related quality of life and caregiver burden, respectively. Resource-use data collected included caregiver time spent with the patient on activities of daily living (ADL). Spearman correlations were computed between EQ-5D scores, ZBI scores, and time spent on instrumental ADL (T-IADL) at baseline, 18 months, and for 18-month change scores. T-IADL and ZBI change scores were summarized by EQ-5D domain change category (better/stable/worse). RESULTS: At baseline, 1495 caregivers had mean EQ-5D index scores of 0.86, 0.85, and 0.82, and ZBI total scores of 24.6, 29.4, and 34.1 for patients with mild, moderate, and moderately severe/severe AD dementia, respectively. Change in T-IADL showed a stronger correlation with change in ZBI (0.12; P < 0.001) than with change in EQ-5D index score (0.02; P = 0.546) although both correlations were very weak. Worsening within EQ-5D domains was associated with increases in ZBI scores, although 68%-90% of caregivers remained stable within each EQ-5D domain. There was no clear pattern for change in T-IADL by change in EQ-5D domain. CONCLUSIONS: EQ-5D may not be the optimum measure of the impact of caring for people with AD dementia due to its focus on physical health. Alternative measures need further investigation.
- Published
- 2017
39. What Drives Country Differences in Cost of Alzheimer's Disease? An Explanation from Resource Use in the GERAS Study
- Author
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Reed C, Happich M, Argimon JM, Haro JM, Wimo A, Bruno G, Dodel R, Jones RW, Vellas B, and Belger M
- Subjects
health resources ,Alzheimer’s disease ,Activities of daily living ,caregivers ,costs - Abstract
BACKGROUND: Country differences in resource use and costs of Alzheimer's disease (AD) may be driven by differences in health care systems and resource availability. OBJECTIVE: To compare country resource utilization drivers of societal costs for AD dementia over 18 months. METHODS: GERAS is an observational study in France (n = 419), Germany (n = 550), and the UK (n = 526). Resource use of AD patients and caregivers contributing to >1% of total societal costs (year 2010) was assessed for country differences, adjusting for participant characteristics. RESULTS: Mean 18-month societal costs per patient were France €33,339, Germany €38,197, and UK €37,899 (£32,501). Caregiver time spent on basic and instrumental activities of daily living (ADL) contributed the most to societal costs (54% France, 64% Germany, 65% UK). Caregivers in France spent less time on ADL than UK caregivers and missed fewer work days than in other countries. Compared with other countries, patients in France used more community care services overall and were more likely to use home aid. Patients in Germany were least likely to use temporary accommodation or to be institutionalized at 18 months. UK caregivers spent the most time on instrumental ADL, UK patients used fewest outpatient resources, and UK patients/caregivers were most likely to receive financial support. CONCLUSION: Caregiver time on ADL contributed the most to societal costs and differed across countries, possibly due to use of community care services and institutionalization. Other resources had different patterns of use across countries, reflecting country-specific health and social care systems.
- Published
- 2017
40. What drives country differences in cost of Alzheimer's Disease? An explanation from resource use in the GERAS Study
- Author
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Reed, C1, Happich, M2, Argimon, Jm3, Haro, Jm4, Wimo, A5, 6, Bruno, Giuseppe, Dodel, R8, Jones, Rw9, Vellas, B10, Author information 1 Eli Lilly, Belger M. 1., Company, Limited, Lilly Research Centre, Windlesham, 2 Lilly Deutschland GmbH, U. K., Bad, Homburg, 3 Divisió d'avaluació, G. e. r. m. a. n. y., Servei Català de la Salut, Barcelona, 4 Parc Santari Sant Joan de Déu, S. p. a. i. n., Cibersam, Universitat de Barcelona, Sant Boi de Llobregat, 5 KI Division of Neurogeriatrics, S. p. a. i. n., Department of Neurobiology, Care, Sciences, Society, Karolinska, Institute, Stockholm, 6 Centre for Research, S. w. e. d. e. n., Development, Uppsala University/Region of Gavleborg, Gävle, 7 Clinica della Memoria, S. w. e. d. e. n., Department of Neurology, Psychiatry, University of Rome Sapienza, Rome, 8 Department of Neurology, I. t. a. l. y., Philipps, University, Marburg, 9 RICE, G. e. r. m. a. n. y., The RICE Centre, Royal United Hospital, Bath, 10 Gerontopole, U. K., Alzheimer's Disease Research, Clinical, Care, Inserm, 1027, Toulouse University Hospital, Toulouse, France, and Universitat de Barcelona
- Subjects
Male ,Gerontology ,Activities of daily living ,França ,International Cooperation ,costs ,Disease ,Atenció domiciliària ,Cohort Studies ,Anglaterra ,0302 clinical medicine ,Cost of Illness ,Surveys and Questionnaires ,Activities of Daily Living ,Health care ,Alemanya (República Federal) ,030212 general & internal medicine ,Aged, 80 and over ,General Neuroscience ,Germany (West) ,Cuidadors ,General Medicine ,Alzheimer's disease ,Home care services ,Europe ,Psychiatry and Mental health ,Clinical Psychology ,Caregivers ,England ,Qualitat de vida ,Health Resources ,Resource use ,Female ,France ,Alzheimer’s disease ,Quality of life ,Resource (biology) ,Institutionalisation ,03 medical and health sciences ,Alzheimer Disease ,medicine ,Humans ,Dementia ,Aged ,Analysis of Variance ,business.industry ,medicine.disease ,Malaltia d'Alzheimer ,caregivers ,health resources ,Observational study ,Geriatrics and Gerontology ,business ,030217 neurology & neurosurgery - Abstract
BACKGROUND: Country differences in resource use and costs of Alzheimer's disease (AD) may be driven by differences in health care systems and resource availability. OBJECTIVE: To compare country resource utilization drivers of societal costs for AD dementia over 18 months. METHODS: GERAS is an observational study in France (n = 419), Germany (n = 550), and the UK (n = 526). Resource use of AD patients and caregivers contributing to >1% of total societal costs (year 2010) was assessed for country differences, adjusting for participant characteristics. RESULTS: Mean 18-month societal costs per patient were France ¿33,339, Germany ¿38,197, and UK ¿37,899 (£32,501). Caregiver time spent on basic and instrumental activities of daily living (ADL) contributed the most to societal costs (54% France, 64% Germany, 65% UK). Caregivers in France spent less time on ADL than UK caregivers and missed fewer work days than in other countries. Compared with other countries, patients in France used more community care services overall and were more likely to use home aid. Patients in Germany were least likely to use temporary accommodation or to be institutionalized at 18 months. UK caregivers spent the most time on instrumental ADL, UK patients used fewest outpatient resources, and UK patients/caregivers were most likely to receive financial support. CONCLUSION: Caregiver time on ADL contributed the most to societal costs and differed across countries, possibly due to use of community care services and institutionalization. Other resources had different patterns of use across countries, reflecting country-specific health and social care systems.
- Published
- 2017
41. CSF neurofilament light differs in neurodegenerative diseases and predicts severity and survival
- Author
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Kaj Blennow, Dorota Religa, Tobias Skillbäck, Katarina Nägga, Lars Rosengren, Maria Eriksdotter, Bahman Farahmand, Anders Wimo, Henrik Zetterberg, Christoffer Rosén, Jonathan M. Schott, Niklas Mattsson, Lena Kilander, Bengt Winblad, and Jonathan W. Bartlett
- Subjects
Male ,Oncology ,medicine.medical_specialty ,Pathology ,Neurology ,Severity of Illness Index ,Neurofilament Proteins ,Predictive Value of Tests ,Internal medicine ,mental disorders ,Severity of illness ,medicine ,Humans ,Dementia ,Registries ,Amyotrophic lateral sclerosis ,Vascular dementia ,Aged ,Aged, 80 and over ,business.industry ,Multiple sclerosis ,Neurodegenerative Diseases ,Middle Aged ,medicine.disease ,Survival Rate ,Female ,Neurology (clinical) ,Alzheimer's disease ,business ,Biomarkers ,Frontotemporal dementia - Abstract
Objectives: We hypothesized that CSF neurofilament light (NFL) levels would be elevated in dementias with subcortical involvement, including vascular dementia (VaD), but less elevated in dementias primarily affecting gray matter structures, such as Alzheimer disease (AD), and that elevated CSF NFL would correlate with disease severity and shorter survival time irrespective of clinical diagnosis. Methods: We included 3,356 individuals with dementia who had CSF NFL analyzed in our laboratory between 2005 and 2012. Clinical diagnoses and Mini-Mental State Examination (MMSE) scores were obtained from the Swedish Dementia Registry, and in selected cases (n = 478), date of death from the Swedish Mortality Registry. Results: CSF NFL differed among clinical diagnoses, with the highest levels seen in frontotemporal dementia, VaD, and mixed AD and VaD. Early-onset AD (younger than 65 years) had the lowest levels. High CSF NFL correlated with low MMSE score and short survival time irrespective of diagnosis, and was also particularly evident in AD. Conclusions: CSF NFL differs among different neurodegenerative diseases and is especially high in dementias engaging subcortical brain regions, such as VaD and mixed AD and VaD, but also in frontotemporal dementia. The association of high CSF NFL levels with disease severity and short survival supports the notion that high CSF NFL levels indicate more aggressive disease processes.
- Published
- 2014
42. The societal costs of dementia in Sweden 2012 – relevance and methodological challenges in valuing informal care
- Author
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Laura Fratiglioni, Anders Gustavsson, Lennarth Johansson, Linus Jönsson, Per-Olof Sandman, Anders Sköldunger, and Anders Wimo
- Subjects
Male ,Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi ,Gerontology ,medicine.medical_specialty ,Cost estimate ,Cognitive Neuroscience ,Clinical Neurology ,Nursing ,Sensitivity and Specificity ,03 medical and health sciences ,Age Distribution ,0302 clinical medicine ,Cost of Illness ,Societal perspective ,Prevalence ,Cost of illness ,Humans ,Relevance (law) ,Medicine ,Dementia ,030212 general & internal medicine ,Activity-based costing ,health care economics and organizations ,Retrospective Studies ,Sweden ,Geriatrics ,Public economics ,business.industry ,Research ,Omvårdnad ,Institutionalization ,Health Care Costs ,Health Care Service and Management, Health Policy and Services and Health Economy ,Alzheimer's disease ,medicine.disease ,Neurology ,Female ,Patient Care ,Neurology (clinical) ,Erratum ,Costing study ,business ,Alzheimer’s disease ,030217 neurology & neurosurgery ,Geriatric psychiatry - Abstract
Background In this study, we sought to estimate the societal cost of illness in dementia in Sweden in 2012 using different costing approaches to highlight methodological issues. Methods We conducted a prevalence-based cost-of-illness study with a societal perspective. Results The societal costs of dementia in Sweden in 2012 were SEK 62.9 billion (approximately €7.2 billion, approximately US$9.0 billion) or SEK 398,000 per person with dementia (approximately €45,000, approximately US$57,000). By far the most important cost item is the cost of institutional care: about 60% of the costs. In the sensitivity analysis, different quantification and costing approaches for informal care resulted in a great variation in the total societal cost, ranging from SEK 60 billion (€6.8 billion, US$8.6 billion) to SEK 124 billion (€14.1 billion, US$17.8 billion). Conclusions The societal costs of dementia are very high. The cost per person with dementia has decreased somewhat, mainly because of de-institutionalisation. The majority of the costs occur in the social care sector, but the costing of informal care is crucial for the cost estimates.
- Published
- 2016
43. P3 Open-Source Model Framework for Health-Economic Evaluation of Early Treatment in Alzheimer's Disease.
- Author
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Handels, R., Wimo, A., Skoldunger, A., Tate, A., Winblad, B., Silvertand, D., Nguyen, L., Jönsson, L., Grimm, S., Aye, S., and Herring, W.
- Subjects
- *
ALZHEIMER'S disease - Published
- 2023
- Full Text
- View/download PDF
44. Practical Lessons from Amyloid Immunotherapy Trials in Alzheimer Disease
- Author
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Anders Wimo, Ulrika Akenine, Vesna Jelic, Niels Andreasen, Francesca Mangialasche, Alina Solomon, Bengt Winblad, and Miia Kivipelto
- Subjects
Male ,Amyloid ,medicine.medical_specialty ,Alternative medicine ,law.invention ,Double-Blind Method ,Randomized controlled trial ,Alzheimer Disease ,Informed consent ,law ,Humans ,Medicine ,Confidentiality ,Psychiatry ,Aged ,Retrospective Studies ,Sweden ,Window of opportunity ,business.industry ,Memory clinic ,Middle Aged ,medicine.disease ,Clinical trial ,Caregivers ,Neurology ,Family medicine ,Female ,Immunotherapy ,Neurology (clinical) ,Alzheimer's disease ,Mental Status Schedule ,business ,Follow-Up Studies - Abstract
Objectives: Amyloid immunotherapy trials are central in Alzheimer disease (AD) drug development, with the potential to influence all future disease-modifying randomized controlled trials (RCTs). This study investigates practical experiences of staff and participants in immunotherapy RCTs. Setting and methods: The Clinical Trial Research Unit of the Memory Clinic at Karolinska University Hospital, Sweden is an experienced centre specialized in Alzheimer RCTs, where four active and passive phase I/II immunotherapy trials are currently ongoing. Meetings were held with staff members, who were asked to describe their experiences and suggest necessary improvements. In addition, a pilot study was conducted to investigate motivations and expectations of participants in immunotherapy RCTs. A questionnaire was sent to 20 patients, and another similar questionnaire to their caregivers. Results: The main issues emphasized by staff members concerned the critical window of opportunity for recruiting RCTs participants, the much higher level of effort required of patients and caregivers in immunotherapy RCTs compared to classical cholinesterase inhibitor RCTs, problematic informed consent procedures, and confidentiality limitations in trials with different sponsors. For patients and caregivers, the main reason for participating in RCTs was the wish to help research and other people, followed by the need for information, continuity of care, safety and support. Compared to patients, caregivers’ expectations of trial results were more realistic. Conclusions: More open debates of practical experiences from different trial centres and sponsors are essential for optimizing trial designs and improving conditions for participants.
- Published
- 2012
45. The worldwide costs of dementia 2015 and comparisons with 2010
- Author
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Anders, Wimo, Maëlenn, Guerchet, Gemma-Claire, Ali, Yu-Tzu, Wu, A Matthew, Prina, Bengt, Winblad, Linus, Jönsson, Zhaorui, Liu, and Martin, Prince
- Subjects
Male ,Cost ,Economics ,Featured Article ,Alzheimer's disease ,Global Health ,Sensitivity and Specificity ,Costs of illness ,Cross-Sectional Studies ,Cost of Illness ,Humans ,Dementia ,Female ,health care economics and organizations ,Retrospective Studies - Abstract
Introduction In 2010, Alzheimer's Disease International presented estimates of the global cost of illness (COI) of dementia. Since then, new studies have been conducted, and the number of people with dementia has increased. Here, we present an update of the global cost estimates. Methods This is a societal, prevalence-based global COI study. Results The worldwide costs of dementia were estimated at United States (US) $818 billion in 2015, an increase of 35% since 2010; 86% of the costs occur in high-income countries. Costs of informal care and the direct costs of social care still contribute similar proportions of total costs, whereas the costs in the medical sector are much lower. The threshold of US $1 trillion will be crossed by 2018. Discussion Worldwide costs of dementia are enormous and still inequitably distributed. The increase in costs arises from increases in numbers of people with dementia and in increases in per person costs., Highlights • The worldwide costs of dementia were estimated at United States (US) $818 billion in 2015. • This estimated worldwide costs represent an increase of 35% since 2010. • Eighty-six percent of the costs occur in high-income countries. • Costs of informal care and the direct costs of social care still contribute similar proportions of total costs, whereas the costs in the medical sector are much lower. • The threshold of US $1 trillion will be crossed by 2018.
- Published
- 2016
46. Defeating Alzheimer's disease and other dementias: a priority for European science and society
- Author
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Serge Gauthier, Philippe Amouyel, Martin Knapp, Chengxuan Qiu, Henry Brodaty, Henrik Zetterberg, Gunhild Waldemar, René J. F. Melis, Bengt Winblad, Francesca Mangialasche, Frank Jessen, Caroline Graff, Khalid Iqbal, Marcel G. M. Olde Rikkert, Miia Kivipelto, Lon S. Schneider, Bruno Dubois, Giovanni B. Frisoni, Philip Scheltens, Thomas P. Sakmar, Gunilla Johansson, Sandrine Andrieu, Jean Georges, Linus Jönsson, Clive Ballard, Agneta Nordberg, Carol Brayne, Anders Wimo, Howard Feldman, Lars O. Tjernberg, Laura Fratiglioni, Reisa A. Sperling, David Edvardsson, Angel Cedazo-Minguez, Neurology, and Amsterdam Neuroscience - Neurodegeneration
- Subjects
medicine.medical_specialty ,Alzheimer`s disease Donders Center for Medical Neuroscience [Radboudumc 1] ,Biomedical Research ,Clinical Sciences ,Disease ,therapy [Dementia] ,ddc:616.89 ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,Alzheimer Disease ,mental disorders ,medicine ,Dementia ,Humans ,ddc:610 ,030212 general & internal medicine ,Psychiatry ,health care economics and organizations ,organization & administration [Biomedical Research] ,Neurology & Neurosurgery ,therapy [Alzheimer Disease] ,economics [Biomedical Research] ,Neurosciences ,medicine.disease ,Clinical neurology ,Europe ,Neurology (clinical) ,Alzheimer's disease ,Psychology ,030217 neurology & neurosurgery - Abstract
Alzheimer's disease (AD) is the leading cause of dementia, and because the primary risk factor for AD is old age, the prevalence of the disease is increasing dramatically with ageing populations worldwide. Even in high-income countries, the cost of medical care and associated societal burdens of dementia threaten to become overwhelming as more people live into old age. In view of the lack of progress in developing a cure for AD and the rapidly increasing costs of dementia, policy makers and governments have a powerful incentive to provide more resources to develop AD therapeutics. The Lancet Neurology Commission was formed with the overarching aim to provide information and expert recommendations to policy makers and political leaders about the growing problem of AD and related dementias of ageing.
- Published
- 2016
47. The cost of diagnosing dementia in a community setting
- Author
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Anders Wimo, Linus Jönsson, Niels Andreasen, Jan Strömqvist, and Erik Jedenius
- Subjects
Gerontology ,medicine.medical_specialty ,Total cost ,mental disorders ,medicine ,Humans ,Dementia ,Prospective Studies ,Medical diagnosis ,Intensive care medicine ,health care economics and organizations ,Average cost ,Aged, 80 and over ,Health economics ,business.industry ,Public health ,Health Care Costs ,medicine.disease ,Community Mental Health Services ,Psychiatry and Mental health ,Community setting ,Geriatrics and Gerontology ,Alzheimer's disease ,business ,Specialization - Abstract
Objectives In order to cope with the increasing number of individuals with dementia, it is crucial to develop the diagnostic capacity in primary care in cooperation with dementia specialists. Further, in order to establish prerequisites for care and planning it is important to identify the cost of dementia diagnosis. This study aims to evaluate the cost of establishing a dementia diagnosis. Methods This is a prospective, time- and resource utilization study for the identification of the total cost associated with diagnosing dementia (from start of the diagnostic process to time for established or rejected dementia diagnosis) both at the specialist and primary care level. Results Dementia evaluation in primary care took between 2 weeks and 2 months before reaching diagnosis. The average cost for all patients evaluated at the primary care level was 477 Euro (€), whereas evaluations done on a specialist level reached a cost of 1115 €. Thus, the costs per true diagnosed case consist of the cost for all dementia investigations divided by the number of finalized diagnoses. Conclusions In this study the cost for diagnosing dementia per true diagnosed patient is 849 € at the primary care level and 1334 € at the specialist level. Based on this result we estimated that the cost of establishing a dementia diagnosis is 1% of the total cost of dementia. Copyright © 2009 John Wiley & Sons, Ltd.
- Published
- 2010
48. The Cost of Dementia in Europe: A Review of the Evidence, and Methodological Considerations
- Author
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Linus Jönsson and Anders Wimo
- Subjects
Gerontology ,medicine.medical_specialty ,Health Services for the Aged ,Cost-Benefit Analysis ,jel:D ,Disease ,jel:C ,Severity of Illness Index ,jel:I ,Health administration ,jel:I1 ,Alzheimer Disease ,medicine ,Dementia ,Humans ,Aged ,Pharmacology ,Health economics ,jel:Z ,Cost–benefit analysis ,business.industry ,Health Policy ,Public health ,Public Health, Environmental and Occupational Health ,Health Care Costs ,medicine.disease ,jel:I11 ,Data availability ,Europe ,Models, Economic ,jel:I18 ,jel:I19 ,Alzheimer's disease ,business - Abstract
Alzheimer's disease (AD) is a leading cause of disability in the elderly, leading to a high burden on caregivers and costs to society. This article describes the current level of data availability regarding the costs of AD in Europe, summarizes and compares findings from previous studies in different countries, and discusses the applicability of available data for modelling purposes. A literature review was conducted for papers in any language reporting data on costs of care for patients with diagnosed dementia or possible/probable AD. Only papers reporting patient-level data on costs were included. A total of 16 studies were identified: from the Nordic region (4), the UK (3), Spain (3), France (2), Italy (2), Belgium (1) and Germany (1). There is large variation in total cost estimates, depending on, for example, differences in study methodology, setting, type and severity of patients included, range of costs assessed and the choice of principle for valuing informal care. The median value for total annual care costs in all studies was €28 000 (range €6614-€64 426) [year 2005 values]. Few studies assessed aspects of disease severity other than cognitive function. The costs of AD in Europe are substantial and increase with disease severity. Methodological differences between studies make comparison across countries and healthcare systems difficult, and there is a need to standardize methods for assessing and valuing informal care. Patient-level information on resource use is required to analyse determinants of care costs and predict the impact of therapeutic interventions. More data are needed to support future economic evaluations of therapies for AD.
- Published
- 2009
49. Alzheimer's disease and vascular dementia in developing countries: prevalence, management, and risk factors
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Elaine K. Perry, Zhen Xin Zhang, Robert Stewart, Raj N. Kalaria, Robert P. Friedland, José A. Luchsinger, Anders Wimo, Raul Arizaga, Martin Prince, Adesola Ogunniyi, Doug R. Galasko, Piero Antuono, Gladys E. Maestre, Kathleen S. Hall, and Felix Potocnik
- Subjects
Gerontology ,Population ageing ,Apolipoprotein E4 ,Population Dynamics ,Developing country ,Comorbidity ,Disease ,Article ,Alzheimer Disease ,Risk Factors ,Environmental health ,mental disorders ,Prevalence ,Humans ,Medicine ,Dementia ,Genetic Predisposition to Disease ,Risk factor ,Vascular dementia ,Developing Countries ,Aged ,Poverty ,business.industry ,Dementia, Vascular ,Incidence ,medicine.disease ,Neurology (clinical) ,Alzheimer's disease ,business - Abstract
Despite mortality due to communicable diseases, poverty, and human conflicts, dementia incidence is destined to increase in the developing world in tandem with the ageing population. Current data from developing countries suggest that age-adjusted dementia prevalence estimates in 65 year olds are high (>or=5%) in certain Asian and Latin American countries, but consistently low (1-3%) in India and sub-Saharan Africa; Alzheimer's disease accounts for 60% whereas vascular dementia accounts for approximately 30% of the prevalence. Early-onset familial forms of dementia with single-gene defects occur in Latin America, Asia, and Africa. Illiteracy remains a risk factor for dementia. The APOE epsilon4 allele does not influence dementia progression in sub-Saharan Africans. Vascular factors, such as hypertension and type 2 diabetes, are likely to increase the burden of dementia. Use of traditional diets and medicinal plant extracts might aid prevention and treatment. Dementia costs in developing countries are estimated to be US$73 billion yearly, but care demands social protection, which seems scarce in these regions.
- Published
- 2008
50. Long-term effects of Alzheimer's disease treatment
- Author
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Anders Wimo
- Subjects
Male ,Pediatrics ,medicine.medical_specialty ,business.industry ,Nootropic Agents ,Memantine ,medicine.disease ,Term (time) ,Nursing Homes ,Alzheimer's disease treatment ,Piperidines ,Alzheimer Disease ,Indans ,Medicine ,Homes for the Aged ,Humans ,Female ,Neurology (clinical) ,Alzheimer's disease ,business ,Nursing homes ,medicine.drug - Published
- 2015
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