Vascular Cognitive Impairment and Dementia Expenditures: 7-Year Inpatient Cost Description in Community Dwellers

Department of Neurology, Jackson Memorial Medical Center/University of Miami Hospital, Miami, FL. .
Postgraduate Medicine (Impact Factor: 1.7). 09/2012; 124(5):91-100. DOI: 10.3810/pgm.2012.09.2597
Source: PubMed


Vascular cognitive impairment (VCI) and vascular dementia (VaD) are prevalent conditions with a growing impact on health care expenses. Few studies have addressed expenditures on cognitive vascular disease. We quantify the expenses of tertiary-care inpatients with VCI and VaD and provide the first report on the specific cost of care in community-dwelling patients with small- and large-vessel ischemic cognitive disease.

This is a cost-description study of inpatient expenditures from the Spanish National Health Institute and regional government perspectives. We retrospectively analyzed the expenses in a prospective cohort of 122 community dwellers with VCI who developed small-vessel disease with ischemic white matter disease (Binswanger's disease) (n = 60), lacunar state (n = 26), or large-vessel disease (n = 36). Admissions with a primary or secondary diagnosis of transient ischemic attack or stroke, cognitive impairment or dementia, and other diagnoses related to cerebrovascular disease were assessed.

The average cost per patient was $33 740. The costs per VCI admission were similar across groups (~$9545). The average number of admissions increased during the progression of the disease (VCI, 1.2; VaD, 2.5) and contributed to higher expenses per patient during the VaD stage (~$22 631) compared with the VCI stage (~$11 110). Half of patients (n = 61; 50%) progressed without ischemic events during the VCI stage. These patients incurred lower per-patient costs during the VCI stage ($9750 vs $12 464), and costs increased during the post-VaD diagnosis stage ($28 528 vs $16 734).

Large- and small-vessel cerebrovascular diseases are common and costly conditions. Vascular cognitive impairment presenting with stroke may incur greater expenses than VCI onset without stroke. Thus, patients with large-vessel disease incurred higher costs during the VCI stage. Care became more onerous at an advanced VaD stage in all groups. During the VaD stage, the expenditures of patients with Binswanger's disease were significantly higher and eventually counterbalanced the initially lower costs seen during the VCI stage.

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    ABSTRACT: The objectives of the study were to explore the prevalence and effects of vascular cognitive impairment (VCI) among ischemic stroke patients and to provide a basis for prevention and treatment strategies. A stratified cluster random sampling method was performed, and 689 ischemic stroke patients (over 40 years of age) were enrolled. All of the patients had received a neuropsychological assessment battery to assess cognitive function and self-designed questionnaires to collect relevant information. According to the cognitive status, the patients were divided into two groups, a case group and a control group. The caregivers of the patients were given a questionnaire concerning the awareness of and attitudes toward VCI. In this study, we determined that the prevalence of VCI was 41.8%. Aging, paraventricular white matter lesion (WML), macroangiopathy, high levels of alcohol, a lack of hobbies, and excessive sleep were risk factors for vascular cognitive impairment no dementia (VCIND). A high level of education, manual-work, low level of alcohol use, regular health checks, a vegetable-based diet, and more fruit and milk were protective factors for VCIND. Living alone, hyperlipidemia, transient ischemic attack, a family history of stroke, and brain atrophy were risk factors of vascular dementia (VD). A high educational level, a vegetable-based diet, and tea were protective factors for VD. The general public awareness of VCI was found to be insufficient, and there was a prejudice toward and lack of funding for the care of VCI patients. The prevalence of VCI is high in ischemic stroke patients, and there are different impact factors at different stages. Despite the high prevalence of VCI, the general public awareness is limited. Appropriate prevention measures should be developed to reduce the prevalence of VCI.
    Archives of gerontology and geriatrics 10/2013; 58(2). DOI:10.1016/j.archger.2013.09.006 · 1.85 Impact Factor