Tahami Monfared Amir Abbas, Khachatryan Artak, Hummel Noemi, Kopiec Agnieszka, Martinez Marta, Zhang Raymond, Zhang Quanwu
Eisai Inc., USA.
McGill University, Montreal, QC, Canada.
J Alzheimers Dis. 2024;99(1):191-206. doi: 10.3233/JAD-231259.
Alzheimer's disease (AD) and mild cognitive impairment (MCI) have negative quality of life (QoL) and economic impacts on patients and their caregivers and may increase along the disease continuum from MCI to mild, moderate, and severe AD.
To assess how patient and caregiver QoL, indirect and intangible costs are associated with MCI and AD severity.
An on-line survey of physician-identified patient-caregiver dyads living in the United States was conducted from June-October 2022 and included questions to both patients and their caregivers. Dementia Quality of Life Proxy, the Care-related Quality of Life, Work Productivity and Activity Impairment, and Dependence scale were incorporated into the survey. Regression analyses investigated the association between disease severity and QoL and cost outcomes with adjustment for baseline characteristics.
One-hundred patient-caregiver dyads were assessed with the survey (MCI, n = 27; mild AD, n = 27; moderate AD, n = 25; severe AD, n = 21). Decreased QoL was found with worsening severity in patients (p < 0.01) and in unpaid (informal) caregivers (n = 79; p = 0.02). Dependence increased with disease severity (p < 0.01). Advanced disease severity was associated with higher costs to employers (p = 0.04), but not with indirect costs to caregivers. Patient and unpaid caregiver intangible costs increased with disease severity (p < 0.01). A significant trend of higher summed costs (indirect costs to caregivers, costs to employers, intangible costs to patients and caregivers) in more severe AD was observed (p < 0.01).
Patient QoL and functional independence and unpaid caregiver QoL decrease as AD severity increases. Intangible costs to patients and summed costs increase with disease severity and are highest in severe AD.
阿尔茨海默病（AD）和轻度认知障碍（MCI）会对患者及其照护者的生活质量（QoL）产生负面影响，并带来经济影响，且可能会随着疾病从MCI发展到轻度、中度和重度AD而增加。
评估患者和照护者的生活质量、间接和无形成本如何与MCI及AD严重程度相关。
2022年6月至10月对美国医生确诊的患者-照护者二元组进行了在线调查，调查向患者及其照护者都提出了问题。调查纳入了痴呆症生活质量代理量表、照护相关生活质量量表、工作效率和活动障碍量表以及依赖程度量表。回归分析在对基线特征进行调整后，研究了疾病严重程度与生活质量及成本结果之间的关联。
通过该调查评估了100个患者-照护者二元组（MCI组27个；轻度AD组27个；中度AD组25个；重度AD组21个）。发现患者（p<0.01）和无薪（非正式）照护者（n=79；p=0.02）的生活质量会随着严重程度的加重而下降。依赖程度随疾病严重程度增加（p<0.01）。疾病严重程度较高与雇主的成本较高相关（p=0.04），但与照护者的间接成本无关。患者和无薪照护者的无形成本随疾病严重程度增加（p<0.01）。观察到在更严重的AD中，总费用（照护者的间接成本、雇主的成本、患者和照护者的无形成本）有显著升高的趋势（p<0.01）。
随着AD严重程度增加，患者的生活质量和功能独立性以及无薪照护者的生活质量会下降。患者的无形成本和总费用随疾病严重程度增加，在重度AD中最高。
