Table 1
Demographics, comorbidities, cognitive status and medication of patients at the Centre for Cognitive Impairments.
| All patients (n=720) | SCI and MCI (n=322) | Dementias (n=258) | Psychiatric disorders and other dg. (n=140) | p-value | |
|---|---|---|---|---|---|
| Age, mean (SD) | 73 (13) | 72 (10) | 80 (8) | 61 (15) | <0.001* |
| Women, n (%) | 427 (59.3) | 189 (58.7) | 149 (57.8) | 89 (63.6) | 0.506 |
| Employed | 47 (6.5) | 19 (5.9) | 3 (1.2) | 25 (17.9) | <0.001 |
| Residency | |||||
| living alone | 114 (23.4) | 58 (27.5) | 46 (22.2) | 10 (14.3) | |
| with a partner or caregiver | 363 (74.4) | 148 (70.1) | 156 (75.4) | 59 (84.3) | 0.199*** |
| nursing home/institution | 11 (2.3) | 5 (2.4) | 5 (2.4) | 1 (1.4) | |
| MMSE, median (IQR) | 27 (4) | 28 (4) | 22 (6) | 28 (5) | <0.001** |
| MMSE 0-10 | 7 (1.5) | 0 | 7 (3.1) | 0 | 0.024*** |
| MMSE 11-20 | 98 (20.3) | 11 (5.0) | 81 (36.3) | 6 (14.6) | <0.001 |
| MMSE 21-30 | 377 (78.2) | 207 (95.0) | 135 (60.5) | 35 (85.4) | <0.001 |
| MoCA, median (IQR) | 22 (7) | 24 (6) | 18 (6) | 25 (4) | <0.001** |
| Antidementives | 348 (48.3) | 91 (28.3) | 237 (91.9) | 20 (14.3) | <0.001 |
| Memantine | 100 (13.9) | 19 (5.9) | 77 (29.8) | 4 (2.9) | <0.001 |
| ChEIs | 293 (40.7) | 77 (23.9) | 200 (77.5) | 16 (11.4) | <0.001 |
| Rivastigmine | 181 (25.1) | 36 (11.2) | 136 (52.7) | 9 (6.4) | <0.001 |
| Galantamine | 45 (6.3) | 12 (3.7) | 30 (11.6) | 3 (2.1) | <0.001 |
| Donepezil | 95 (13.2) | 36 (11.2) | 52 (20.2) | 7 (5.0) | <0.001 |
| Antidepressants | 372 (51.7) | 152 (47.2) | 131 (50.8) | 89 (63.6) | 0.005 |
| First visit in 2015 | 374 (51.9) | 181 (56.2) | 109 (42.2) | 84 (60.0) | 0.001 |
| Total number of imaging/ neurophysiological examinations (CT, MRI, FDG-PET, DaT scan, EEG) | 723 (100) | 317 (43.8) | 282 (39.0) | 124 (17.2) | / |
[i] Unless stated otherwise, the data is represented as number of cases (n) and percentage proportion (%). Unless stated otherwise, the p-values were obtained by chi-square. Employment status and residency were recorded only at the first examination. *ANOVA,
**Kruskal-Wallis test, ***Fisher’s exact test ChEIs – cholinesterase inhibitors, CT – computerised tomography, DaT scan – dopamine transporter scan, EEG – electroencephalography,
FDG-PET – fluorodeoxyglucose positron emission tomography, IQR – interquartile range, MCI – mild cognitive impairment, MMSE – mini-mental state examination, MoCA – Montreal cognitive assessment, MRI – magnetic resonance imaging, SCI – subjective cognitive impairment, SD – standard deviation
Table 2
Costs of diagnostic procedures and treatment performed in 2015.
| No of ptn | Costs (EUR) | No of ptn | Costs (EUR) | No of ptn | Costs (EUR) | No of ptn | Costs (EUR) | ||
|---|---|---|---|---|---|---|---|---|---|
| First visit | 17.3 | 374 | 6,470 | 181 | 3,131 | 109 | 1,886 | 84 | 1,453 |
| Follow-up visits | 8.65 | 514 | 4,446 | 214 | 1,851 | 198 | 1,713 | 102 | 882 |
| Basic blood panel | 34.46 | 374 | 12,888 | 181 | 6,237 | 109 | 3,756 | 84 | 2,895 |
| Vitamin B12, folic acid, homocysteine | 41.53 | 374 | 15,532 | 181 | 7,517 | 109 | 4,527 | 84 | 3,489 |
| Thyroid function (TSH, T4, T3) | 20.14 | 374 | 7,532 | 181 | 3,645 | 109 | 2,195 | 84 | 1,692 |
| MRI | 250.72 | 108 | 27,078 | 61 | 15,294 | 28 | 7,020 | 19 | 4,764 |
| CT | 88.97 | 28 | 2,491 | 7 | 623 | 16 | 1,424 | 5 | 445 |
| LP | 1,499.69 | 61 | 91,481 | 37 | 55,489 | 20 | 29,994 | 4 | 5,999 |
| Neuropsychological examination | 230.01 | 94 | 21,621 | 65 | 14,951 | 17 | 3,910 | 12 | 2,760 |
| FDG-PET | 928.67 | 32 | 29,717 | 20 | 18,573 | 8 | 7,429 | 4 | 3,715 |
| DaT scan | 1,235.31 | 13 | 16,059 | 3 | 3,706 | 4 | 4,941 | 6 | 7,412 |
| EEG | 49.33 | 49 | 2,417 | 21 | 1,036 | 15 | 740 | 13 | 641 |
| Dg. – cost per group (EUR) | 237,733 | 132,053 | 69,535 | 36,146 | |||||
| Dg. – cost per person (EUR) | 330 | 412 | 268 | 258 | |||||
| Anti-dementia treatment/month ChEI | 40.8 | 293 | 143,453 | 77 | 37,699 | 200 | 97,920 | 16 | 7,834 |
| Memantine | 29.3 | 100 | 35,160 | 19 | 6,680 | 77 | 27,073 | 4 | 1,406 |
| Med. – cost per group (EUR) | 178,613 | 44,380 | 124,993 | 9,240 | |||||
| Med. – cost per person (EUR) | 248 | 138 | 483 | 66 | |||||
| All – cost per group (EUR) | 416,346 | 176,433 | 194,528 | 45,386 | |||||
| All – cost per person (EUR) | 578 | 550 | 751 | 324 |
[i] Costs are reported in euros.
EUR – euro, BDI – Beck Depression Inventory, ChEIs – cholinesterase inhibitors, CT – computerised tomography, dg – diagnoses, FDG-PET
– fluorodeoxyglucose positron emission tomography, LP – lumbar puncture with dementia biomarkers cerebrospinal fluid analysis, MCI
– mild cognitive impairment, Med. – medications, MMSE – mini-mental state examination, MoCA – Montreal cognitive assessment, No – number, SCI – subjective cognitive impairment
Table 3
Informal and social care monthly costs in patients with and without dementia.
| Patients with dementia (n=120) | Patients without dementia (n=92) | p-value | |
|---|---|---|---|
| Age, median (IQR) | 81 (10) | 81 (9) | 0.580 |
| Women, n (%) | 73 (60.8) | 63 (68.5) | 0.250a |
| Number of caregivers, median (IQR) | 2 (4) | 2 (4) | 0.840 |
| Type of help and costs | Difference | ||
| Informal care: ADLs (hours/month) | 118 | 77 | 41 |
| Informal care: opportunity cost (EUR/month (95% CI)) | EUR 894 (725–1103) | EUR 561 (445–707) | EUR 333 |
| Home help (hours/month) | 3.1 | 3.6 | -0.5 |
| Home help costs (EUR/month; (95% CI))* | EUR 53 (21–85) | EUR 60 (23–98) | -EUR 7 |
| Nursing home placement, n (%) | 17 (14.2%) | 3 (3.3%) | |
| Nursing home cost (EUR/month (95% CI))* | EUR 114 (69–158) | EUR 15 (-37–66) | EUR 99 |
| Total costs: opportunity cost (95% CI)** | EUR 1,037 (897–1177) | EUR 656 (500–812) | EUR 381 |
[i] Unless stated otherwise, variables are reported as estimated marginal means. P-values were obtained the Mann-Whitney U-test, aChi-square test
Total costs are the costs of informal care (ADLs), home help and nursing home placement.
ADLs – activities of daily living (basic and instrumental), EUR – euro, IQR – interquartile range, CI – confidence interval
*Owing to the many zero values, a general linear model was applied here.
**Due to regression analyses, the total costs are not identical to the sums of the components.
Table 4
Sensitivity analysis of informal and social care costs in patients with and without dementia.
| Patients with dementia (n=120) | Patients without dementia (n=92) | Difference | |
|---|---|---|---|
| ADLs (hours/month) | 118 | 77 | 41 |
| Replacement costs | EUR 2,028 (1,728–2,327) | EUR 1,312 (978–1,646) | EUR 716 |
| ADLs and supervision (hours/month) | 188 | 102 | 86 |
| Opportunity costs | EUR 1,392 (1,169–1,617) | EUR 790 (560–1,019) | EUR 602 |
| Replacement costs | EUR 3,173 (2,663–363) | EUR 1,798 (1,275–2,322) | EUR 1,375 |
| Home help costs (EUR/month) | EUR 53 (21–85) | EUR 60 (23–98) | / |
| Nursing home costs (EUR/month) | EUR 114 (69–158) | EUR 15 (-37–66) | EUR 99 |
| Total costs with informal care ADL replacement costs (EUR/month) | EUR 2,174 (1,873–2,475) | EUR 1,392 (1,056–1,723) | EUR 782 |
| Total costs with informal care ADL and supervision opportunity costs (EUR/month) | EUR 1,495 (1,265–1,726) | EUR 872 (635–1,108) | EUR 623 |
| Total costs with informal care ADL and supervision replacement costs (EUR/month) | EUR 3,369 (2,856–3,880) | EUR 1,895 (1,370–2,420) | EUR 1474 |
Table 5
Different diagnostic pathways and their costs when a cognitive disorder is suspected.
| Diagnostic packages | Costs (EUR) for 2021 |
|---|---|
| Exam + lab + CT | 207 |
| Exam + lab + MRI | 365 |
| Exam + lab + MRI + NP | 622 |
| Exam + lab + MRI + LP | 2,922 |
| Exam + lab + MRI + FDG-PET | 1,296 |
| Exam + lab + MRI + LP + FDG-PET | 1,553 |
| Exam + lab + MRI + NP + LP | 3,179 |
| Exam + lab + MRI + NP + FDG-PET | 3,853 |
| Exam + lab + MRI + NP + LP + FDG-PET | 4,110 |
[i] Exam: detailed history, general neurological examination, screening cognitive examination
Lab: basic and extended laboratory tests
CT – computerised tomography, FDG-PET – fluorodeoxyglucose positron emission tomography, LP – lumbar puncture with dementia biomarkers cerebrospinal fluid analysis, MRI – magnetic resonance imaging, NP – neuropsychology
Figure 1
Changes in diagnostic groups from first to last visit.