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Predictors of Costs in Dementia in a Longitudinal Perspective  [PDF]
Hanna Leicht, Hans-Helmut K?nig, Nina Stuhldreher, Cadja Bachmann, Horst Bickel, Angela Fuchs, Kathrin Heser, Frank Jessen, Mirjam K?hler, Melanie Luppa, Edelgard M?sch, Michael Pentzek, Steffi Riedel-Heller, Martin Scherer, Jochen Werle, Siegfried Weyerer, Birgitt Wiese, Wolfgang Maier, for the AgeCoDe study group
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0070018
Abstract: Objective To analyse predictors of costs in dementia from a societal perspective in a longitudinal setting. Method Healthcare resource use and costs were assessed retrospectively using a questionnaire in four waves at 6-month intervals in a sample of dementia patients (N = 175). Sociodemographic data, dementia severity and comorbidity at baseline, cognitive impairment and impairment in basic and instrumental activities of daily living were also recorded. Linear mixed regression models with random intercepts for individuals were used to analyse predictors of total and sector-specific costs. Results Impairment in activities of daily living significantly predicted total costs in dementia patients, with associations between basic activities of daily living and formal care costs on the one and instrumental activities of daily living and informal care costs on the other hand. Nursing home residence was associated with lower total costs than residence in the community. There was no effect of cognition on total or sector-specific costs. Conclusion Cognitive deficits in dementia are associated with costs only via their effect on the patients' capacity for activities of daily living. Transition into a nursing home may reduce total costs from a societal perspective, owing to the fact that a high amount of informal care required by severely demented patients prior to transition into a nursing home may cause higher costs than inpatient nursing care.
Disturbed oscillatory brain dynamics in subcortical ischemic vascular dementia  [cached]
van Straaten Elisabeth CW,de Haan Willem,de Waal Hanneke,Scheltens Philip
BMC Neuroscience , 2012, DOI: 10.1186/1471-2202-13-85
Abstract: Background White matter hyperintensities (WMH) can lead to dementia but the underlying physiological mechanisms are unclear. We compared relative oscillatory power from electroencephalographic studies (EEGs) of 17 patients with subcortical ischemic vascular dementia, based on extensive white matter hyperintensities (SIVD-WMH) with 17 controls to investigate physiological changes underlying this diagnosis. Results Differences between the groups were large, with a decrease of relative power of fast activity in patients (alpha power 0.25 ± 0.12 versus 0.38 ± 0.13, p = 0.01; beta power 0.08 ± 0.04 versus 0.19 ± 0.07; p<0.001) and an increase in relative powers of slow activity in patients (theta power 0.32 ± 0.11 versus 0.14 ± 0.09; p<0.001 and delta power 0.31 ± 0.14 versus 0.23 ± 0.09; p<0.05). Lower relative beta power was related to worse cognitive performance in a linear regression analysis (standardized beta = 0.67, p<0.01). Conclusions This pattern of disturbance in oscillatory brain activity indicate loss of connections between neurons, providing a first step in the understanding of cognitive dysfunction in SIVD-WMH.
Comparing coding between interventional radiologists and hospital coding departments
J Cox, N Koutroumanos
Clinical Audit , 2010, DOI: http://dx.doi.org/10.2147/CA.S9634
Abstract: mparing coding between interventional radiologists and hospital coding departments Other (3841) Total Article Views Authors: J Cox, N Koutroumanos Published Date May 2010 Volume 2010:2 Pages 33 - 36 DOI: http://dx.doi.org/10.2147/CA.S9634 J Cox1, N Koutroumanos1 1Department of Radiology, University Hospital North Durham, Durham, UK Purpose: The purpose of this audit was to assess whether there was a difference in the health care resource groups coding and subsequent reimbursement of interventional radiology cases, depending on whether the coding was carried out by a clinician or an administrator in the coding department Methodology: A retrospective analysis was undertaken of 137 consecutive patients who had therapeutic endovascular procedures in our Trust from 2005–2007. Six patients were excluded due to lack of data. The audit was carried out at a single center. A single clinician, under the supervision of a consultant interventional radiologist, proceeded to code the procedure after referring to the patient’s radiology report and notes. Findings: The error rate by part of the coding department in terms of assessing nonelective versus elective procedures was 7%. This had lead to a £2,352 excess charge on the part of the coding department. Additionally, there were errors in a further 19 procedures (15%), in which vascular stents had been inserted during the procedure but had not been coded for. The stent usage had not been recognised by the coding administrators in their evaluation, and this equipment-based undercoding resulted in underpayment by the patient’s primary care trust of £11,153. Originality/value: This is the first published audit of coding in interventional radiology in the UK. Coding in complex subspecialties like vascular interventional radiology requires more clinical input and engagement to ensure the case complexity is accurately reflected in the codes assigned and in the subsequent reimbursement.
Acute ischemic heart disease and interventional cardiology: a time for pause
Peter Bogaty, James M Brophy
BMC Medicine , 2006, DOI: 10.1186/1741-7015-4-25
Abstract: This review presents another perspective, based on a critical reexamination of the evidence. The topics addressed are: reperfusion treatment of ST-elevation myocardial infarction; the indications for invasive intervention following thrombolysis; the role of invasive management in non-ST-elevation myocardial infarction and unstable angina; and cost-effectiveness and real world considerations. A few cases encountered in recent practice in community and tertiary hospitals are presented for illustrative purposes The numerous and far-reaching scientific, economic, and philosophical implications that are a consequence of this marked change in clinical practice as well as healthcare, decisional and conflict of interest issues are explored.The weight of evidence does not support the contemporary unfocused broad use of invasive interventional procedures across the spectrum of acute coronary clinical presentations. Excessive and unselective recourse to these procedures has deleterious implications for the organization of cardiac health care and undesirable economic, scientific and intellectual consequences. It is suggested that there is need for a new equilibrium based on more refined clinical risk stratification in the treatment of patients who present with acute coronary syndromes.Over the past few years, a major change has occurred in the approach to patients presenting with acute coronary syndromes (ACS), from predominantly expectant medical management, based on specific clinical presentation, response to initial treatment, evolution, and results of noninvasive risk stratification, towards rapid and increasingly systematic coronary angiography. This change has paved the way to percutaneous coronary revascularization (PCI), largely driven by angiographically perceived coronary anatomy and technical feasibility. Clinical success tends to be measured in terms of the physician's satisfaction with the immediate angiographic result of the intervention, ever easier and safer to
Longitudinal Grey and White Matter Changes in Frontotemporal Dementia and Alzheimer’s Disease  [PDF]
Lars Frings, Belinda Yew, Emma Flanagan, Bonnie Y. K. Lam, Michael Hüll, Hans-Jürgen Huppertz, John R. Hodges, Michael Hornberger
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0090814
Abstract: Behavioural variant frontotemporal dementia (bvFTD) and Alzheimer’s disease (AD) dementia are characterised by progressive brain atrophy. Longitudinal MRI volumetry may help to characterise ongoing structural degeneration and support the differential diagnosis of dementia subtypes. Automated, observer-independent atlas-based MRI volumetry was applied to analyse 102 MRI data sets from 15 bvFTD, 14 AD, and 10 healthy elderly control participants with consecutive scans over at least 12 months. Anatomically defined targets were chosen a priori as brain structures of interest. Groups were compared regarding volumes at clinic presentation and annual change rates. Baseline volumes, especially of grey matter compartments, were significantly reduced in bvFTD and AD patients. Grey matter volumes of the caudate and the gyrus rectus were significantly smaller in bvFTD than AD. The bvFTD group could be separated from AD on the basis of caudate volume with high accuracy (79% cases correct). Annual volume decline was markedly larger in bvFTD and AD than controls, predominantly in white matter of temporal structures. Decline in grey matter volume of the lateral orbitofrontal gyrus separated bvFTD from AD and controls. Automated longitudinal MRI volumetry discriminates bvFTD from AD. In particular, greater reduction of orbitofrontal grey matter and temporal white matter structures after 12 months is indicative of bvFTD.
Predictors of nursing home admission of individuals without a dementia diagnosis before admission - results from the Leipzig Longitudinal Study of the Aged (LEILA 75+)
Melanie Luppa, Tobias Luck, Herbert Matschinger, Hans-Helmut K?nig, Steffi G Riedel-Heller
BMC Health Services Research , 2010, DOI: 10.1186/1472-6963-10-186
Abstract: Data were derived from the Leipzig Longitudinal Study of the Aged, a population-based study of individuals aged 75 years and older. 1,024 dementia-free older adults were interviewed six times on average every 1.4 years. Socio-demographic, clinical, and psychometric variables were obtained. Kaplan-Meier estimates were used to determine mean time to NHA. Cox proportional hazards regression was used to examine predictors of long-term NHA.Of the overall sample, 7.8 percent of the non-demented elderly (n = 59) were admitted to nursing home (NH) during the study period. The mean time to NHA in the dementia-free sample was 7.6 years. Characteristics associated with a shorter time to NHA were increased age, living alone, functional and cognitive impairment, major depression, stroke, myocardial infarction, a low number of specialist visits and paid home helper use.Severe physical or psychiatric diseases and living alone have a significant effect on NHA for dementia-free individuals. The findings offer potentialities of secondary prevention to avoid or delay NHA for these elderly individuals. Further investigation of predictors of institutionalization is warranted to advance understanding of the process leading to NHA for this important group.Demographic changes will lead to a considerable increase in the numbers and proportion of elderly in most developed countries after the year 2010 [1]. This demographic trend associated with a higher incidence of chronic conditions and a rapid advance in medical technology may cause a steep rise in the number of institutionalised elderly people [1]. In Germany, the number of nursing home residents increased by nearly 6 percent between the years 2003 and 2005, and by 18 percent since 1999. Altogether, 32 percent of individuals in need of care live in nursing homes [2].The research looking at risk factors of NHA has substantially increased in the last decades [3-5]. Many early studies analysed factors using a cross-sectional design and/or u
Abnormal Organization of White Matter Network in Patients with No Dementia after Ischemic Stroke  [PDF]
Lin Shi, Defeng Wang, Winnie C. W. Chu, Shangping Liu, Yunyun Xiong, Yilong Wang, Yongjun Wang, Lawrence K. S. Wong, Vincent C. T. Mok
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0081388
Abstract: Structural changes after ischemic stroke could affect information communication extensively in the brain network. It is likely that the defects in the white matter (WM) network play a key role in information interchange. In this study, we used graph theoretical analysis to examine potential organization alteration in the WM network architecture derived from diffusion tensor images from subjects with no dementia and experienced stroke in the past 5.4–14.8 months (N = 47, Mini-Mental Screening Examination, MMSE range 18–30), compared with a normal control group with 44 age and gender-matched healthy volunteers (MMSE range 26–30). Region-wise connectivity was derived from fiber connection density of 90 different cortical and subcortical parcellations across the whole brain. Both normal controls and patients with chronic stroke exhibited efficient small-world properties in their WM structural networks. Compared with normal controls, topological efficiency was basically unaltered in the patients with chronic stroke, as reflected by unchanged local and global clustering coefficient, characteristic path length, and regional efficiency. No significant difference in hub distribution was found between normal control and patient groups. Patients with chronic stroke, however, were found to have reduced betweenness centrality and predominantly located in the orbitofrontal cortex, whereas increased betweenness centrality and vulnerability were observed in parietal-occipital cortex. The National Institutes of Health Stroke Scale (NIHSS) score of patient is correlated with the betweenness centrality of right pallidum and local clustering coefficient of left superior occipital gyrus. Our findings suggest that patients with chronic stroke still exhibit efficient small-world organization and unaltered topological efficiency, with altered topology at orbitofrontal cortex and parietal-occipital cortex in the overall structural network. Findings from this study could help in understanding the mechanism of cognitive impairment and functional compensation occurred in patients with chronic stroke.
Quality of life of residents with dementia in long-term care settings in the Netherlands and Belgium: design of a longitudinal comparative study in traditional nursing homes and small-scale living facilities
Alida HPM de Rooij, Katrien G Luijkx, Anja G Declercq, Jos MGA Schols
BMC Geriatrics , 2011, DOI: 10.1186/1471-2318-11-20
Abstract: A longitudinal comparative study in traditional and small-scale long-term care settings, which follows a quasi-experimental design, will be carried out in Belgium and the Netherlands. To answer the research question, a model has been developed which incorporates relevant elements influencing quality of life in long-term care settings. Validated instruments will be used to evaluate the role of these elements, divided into environmental characteristics (country, type of ward, group size and nursing staff); basic personal characteristics (age, sex, cognitive decline, weight and activities of daily living); behavioural characteristics (behavioural problems and depression); behavioural interventions (use of restraints and use of psychotropic medication); and social interaction (social engagement and visiting frequency of relatives). The main outcome measure for residents in the model is quality of life. Data are collected at baseline, after six and twelve months, from residents living in either small-scale or traditional care settings.The results of this study will provide an insight into the determinants of quality of life for people with dementia living in traditional and small-scale long-term care settings in Belgium and the Netherlands. Possible relevant strengths and weaknesses of the study are discussed in this article.ISRCTN: ISRCTN23772945The substantial increase in the number of people with dementia worldwide implies that there will be much greater demand for both home care and residential care in the future [1]. For the Netherlands, the expectation is that in 2030 there will be 319,312 people with dementia, an increase of 65% over a period of 25 years [2]. The expectation for Belgium is that there will be 251,000 people aged over 65 with dementia in 2030, a rise of 56% over 25 years [3].People usually prefer home care over residential care, but for a substantial number of people in the later stages of dementia staying at home is no longer possible [4]. In the l
Abnormal Intrinsic Brain Activity Patterns in Patients with Subcortical Ischemic Vascular Dementia  [PDF]
Chen Liu, Chuanming Li1, Xuntao Yin, Jun Yang, Daiquan Zhou, Li Gui, Jian Wang
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0087880
Abstract: Objectives To investigate the amplitude of low-frequency fluctuations (ALFF) alteration of whole brain in patients with subcortical ischemic vascular dementia (SIVD). Materials and Methods Thirty patients with SIVD and 35 control subjects were included in this study. All of them underwent structural MRI and rs-fMRI scan. The structural data were processed using the voxel-based morphometry 8 toolbox (VBM8). The rs-fMRI data were processed using Statistical Parametric Mapping (SPM8) and Data Processing Assistant for Resting-State fMRI (DPARSF) software. Within-group analysis was performed with a one-sample Student's t-test to identify brain regions with ALFF value larger than the mean. Intergroup analysis was performed with a two-sample Student's t-test to identify ALFF differences of whole brain between SIVD and control subjects. Partial correlations between ALFF values and Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) scores were analyzed in the SIVD group across the parameters of age, gender, years of education, and GM volume. Results Within-group analysis showed that the bilateral anterior cingulate cortex (ACC), posterior cingulate cortex, medial prefrontal cortex (MPFC), inferior parietal lobe (IPL), occipital lobe, and adjacent precuneus had significantly higher standardized ALFF values than the global mean ALFF value in both groups. Compared to the controls, patients with SIVD presented lower ALFF values in the bilateral precuneus and higher ALFF values in the bilateral ACC, left insula and hippocampus. Including GM volume as an extra covariate, the ALFF inter-group difference exhibited highly similar spatial patterns to those without GM volume correcting. Close negative correlations were found between the ALFF values of left insula and the MoCA and MMSE scores of SIVD patients. Conclusion SIVD is associated with a unique spontaneous aberrant activity of rs-fMRI signals, and measurement of ALFF in the precuneus, ACC, insula, and hippocampus may aid in the detection of SIVD.
A Voxel-based Morphometric Analysis of Cerebral Gray Matter in Subcortical Ischemic Vascular Dementia Patients and Normal Aged Controls  [cached]
Chuanming Li, Hanjian Du, Jian Zheng, Jian Wang
International Journal of Medical Sciences , 2011,
Abstract: BACKGROUND AND PURPOSE: The present study was designed to detect the abnormalities of the cerebral grey-matter density in subcortical ischemic vascular dementia patients by FSL-VBM method to promote the early diagnosis of it. METHODS: Nine subcortical ischemic vascular dementia patients and nine age-matched normal controls underwent MRI brain structure scanning that was performed on a SIEMENS AVANTO 1.5 Tesla scanner and standard T1-weighted high-resolution anatomic scans of MPRAGE sequence were obtained. The 3-demensional MPRAGE images were processed with FSL-VBM package and the cerebral gray matter density was compared between the subcortical ischemic vascular dementia patients and normal controls. RESULTS: Compared with the normal control group, the cerebral gray matter density of subcortical ischemic vascular dementia patients was found significantly decreasing, including brain regions of thalamus, parietal lobe, frontal lobe and temporal lobe (P<0.05). CONCLUSIONS: The cerebral gray matter density alterations have closed correlation with cognitive dysfunction in subcortical ischemic vascular dementia patient and can be detected by MRI. MRI has some potential value in the diagnosis of them.
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