title: Dependence in Alzheimer's disease and service use costs, quality of life, and caregiver burden: the DADE study.
abstract: BACKGROUND
  Most models determining how patient and caregiver characteristics and costs change with Alzheimer's disease (AD) progression focus on one aspect, for example, cognition. AD is inadequately defined by a single domain; tracking progression by focusing on a single aspect may mean other important aspects are insufficiently addressed. Dependence has been proposed as a better marker for following disease progression.
  
  
  METHODS
  This was a cross-sectional observational study (18 UK sites). Two hundred forty-nine community or institutionalized patients, with possible/probable AD, Mini-Mental State Examination (3-26), and a knowledgeable informant participated.
  
  
  RESULTS
  Significant associations noted between dependence (Dependence Scale [DS]) and clinical measures of severity (cognition, function, and behavior). Bivariate and multivariate models demonstrated significant associations between DS and service use cost, patient quality of life, and caregiver perceived burden.
  
  
  CONCLUSIONS
  The construct of dependence may help to translate the combined impact of changes in cognition, function, and behavior into a more readily interpretable form. The DS is useful for assessing patients with AD in clinical trials/research.
authors: RICE (The Research Institute for the Care of Older People), Royal United Hospital, Bath, UK. Electronic address: r.w.jones@bath.ac.uk.
authors: Roy W
authors: RW
authors: Jones
authors: Centre for the Economics of Mental and Physical Health, Institute of Psychiatry, King's College London, London, UK.
authors: Renee
authors: R
authors: Romeo
authors: School of Social Sciences, Nottingham Trent University, Nottingham, UK.
authors: Richard
authors: R
authors: Trigg
authors: Centre for the Economics of Mental and Physical Health, Institute of Psychiatry, King's College London, London, UK; LSE Health and Social Care, London School of Economics and Political Science, London, UK.
authors: Martin
authors: M
authors: Knapp
authors: LSE Health and Social Care, London School of Economics and Political Science, London, UK.
authors: Azusa
authors: A
authors: Sato
authors: LSE Health and Social Care, London School of Economics and Political Science, London, UK.
authors: Derek
authors: D
authors: King
authors: Niecko Health Economics, Naples, FL, USA.
authors: Timothy
authors: T
authors: Niecko
authors: Janssen Alzheimer Immunotherapy, Dublin, Ireland.
authors: Loretto
authors: L
authors: Lacey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000191:economics* / Q000523:psychology*; D017028:Caregivers / Q000523:psychology*; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D018450:Disease Progression; D004739:England; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011788:Quality of Life; D012720:Severity of Illness Index
keywords: Alzheimer's disease; Caregiver burden; Dependence; England; Pharmacoeconomics; Quality of life; Service use costs