title: Effects of Cognition, Function, and Behavioral and Psychological Symptoms on Medicare Expenditures and Health Care Utilization for Persons With Dementia.
abstract: BACKGROUND
  Clinical features of dementia (cognition, function, and behavioral/psychological symptoms [BPSD]) may differentially affect Medicare expenditures/health care utilization.
  
  
  METHODS
  We linked cross-sectional data from the Aging, Demographics, and Memory Study to Medicare data to evaluate the association between dementia clinical features among those with dementia and Medicare expenditures/health care utilization (n = 234). Cognition was evaluated using the Mini-Mental State Examination (MMSE). Function was evaluated as the number of functional limitations (0-10). BPSD was evaluated as the number of symptoms (0-12). Expenditures were estimated with a generalized linear model (log-link and gamma distribution). Number of hospitalizations, institutional outpatient visits, and physician visits were estimated with a negative binomial regression. Medicare covered skilled nursing days were estimated with a zero-inflated negative binomial model.
  
  
  RESULTS
  Cognition and BPSD were not associated with expenditures. Among individuals with less than seven functional limitations, one additional limitation was associated with $123 (95% confidence interval: $19-$227) additional monthly Medicare spending. Better cognition and poorer function were associated with more hospitalizations among those with an MMSE less than three and less than six functional limitations, respectively. BPSD had no effect on hospitalizations. Poorer function and fewer BPSD were associated with more skilled nursing among individuals with one to seven functional limitations and more than four symptoms, respectively. Cognition had no effect on skilled nursing care. No clinical feature was associated with institutional outpatient care. Of individuals with an MMSE less than 15, poorer cognition was associated with fewer physician visits. Among those with more than six functional limitations, poorer function was associated with fewer physician visits.
  
  
  CONCLUSIONS
  Poorer function, not cognition or BPSD, was associated with higher Medicare expenditures.
authors.affiliation: Division of Health Policy and Management, School of Public Health.
authors.forename: Eric
authors.initials: E
authors.lastname: Jutkowitz
authors.affiliation: Division of Health Policy and Management, School of Public Health.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Kane
authors.affiliation: Division of Health Policy and Management, School of Public Health.
authors.forename: Bryan
authors.initials: B
authors.lastname: Dowd
authors.affiliation: School of Nursing and.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Gaugler
authors.affiliation: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis.
authors.forename: Richard F
authors.initials: RF
authors.lastname: MacLehose
authors.affiliation: Division of Health Policy and Management, School of Public Health.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Kuntz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition; D003430:Cross-Sectional Studies; D003704:Dementia / Q000453:epidemiology / Q000523:psychology*; D004185:Disability Evaluation; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006760:Hospitalization; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics; D009483:Neuropsychological Tests; D009819:Office Visits; D012866:Skilled Nursing Facilities; D014481:United States / Q000453:epidemiology
keywords: Alzheimer’s disease costs; Dementia and Medicare expenditures; Dementia care; Health care utilization