Objective: To investigate the societal costs associated with incident cases of Alzheimer’s disease (AD) and Vascular Cognitive Impairment (VCI) in the five-year follow-up of the Canadian Study of Health and Aging (CSHA) cohort.
Design: Five-year prospective cohort study.
Materials and methods: Societal costs were estimated according to a standard protocol. (Stroke 2002;33:1605-9) VCI and AD were diagnosed by clinical examination, and subgrouped as vascular dementia (VaD), mixed Alzheimer’s disease (AD) and VaD, and cognitive impairment from vascular causes that does not meet the criteria for dementia (VascCIND).
Results: Of the 6,598 survivors considered to have no cognitive impairment at baseline, there were 266 cases of incident VCI and 223 cases of incident AD. Only mild cognitive impairment (MMSE > 20) was present for the majority of both groups. Estimates of societal costs were based on: residence in institutional care, use of community services, unpaid direct care time, and unpaid net supervision time. Standard costs as used in our previous analyses were applied to each cost component. The mean annual cost per person with incident VCI was $43,702 and per person with incident AD was $39,062. These costs are not statistically different despite significantly higher rates of institutionalization for incident AD vs. incident VCI patients (46% vs 32%). The higher institutional costs of incident AD patients are offset somewhat by the greater caregiver time spent with incident VCI patients.
Conclusion: In this population-based sample of elderly Canadians, most incident cases of VCI and AD showed relatively mild cognitive impairment and the 5-year incidence rates and societal costs of VCI and AD were very similar among survivors who had had no cognitive impairment at baseline. As we were unable to estimate incident VCI amongst those who died, these are conservative estimates of the societal costs of VCI.
VCI represents a heterogeneous grouping of patients including those with: In the prevalence phase of the Canadian Study of Health and Aging (CSHA), a population-based study of over 10,267 Canadians aged 65 and over, we found considerable societal costs associated with VCI Curiously, while costs of institutional care remained the most expensive individual cost, unlike AD, no clear gradient related costs to severity of cognitive impairment among persons with VCI.
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