Non-drug interventions for patients with Alzheimer’s are both effective and cost-effective, study shows
A Brown-led research team used a computer simulation to show that compared to usual care, four dementia-care interventions saved up to $13,000 in costs, reduced nursing home admissions and improved quality of life.
Peer-Reviewed PublicationPROVIDENCE, R.I. [Brown University] — While new drugs to treat Alzheimer’s disease tend to receive the most public attention, many well-researched ways to care for people with dementia don’t involve medication. A new evaluation compared the cost-effectiveness of four non-drug interventions to the usual care received by people with dementia and found that the interventions not only resulted in a better quality of life, but also saved money.
In a study published April 6 in Alzheimer's & Dementia: The Journal of the Alzheimer's Association, researchers used a computer simulation model to show that the four dementia-care interventions saved between $2,800 and $13,000 in societal costs, depending on the type of intervention, and all reduced nursing home admissions and improved quality of life compared to usual care.
Alzheimer’s drugs hold great promise, but they still need additional research and improvement, said lead study author Eric Jutkowitz, an associate professor at Brown University’s School of Public Health. In the meantime, he said, a number of non-drug interventions have been shown to be effective in clinical trials in improving quality of life for people with dementia and helping them stay safely at home longer.
“Now that we can show that these effective interventions can also save money, it just makes sense to find ways to make them available to more families,” Jutkowitz said. “These interventions can be used to help people with dementia starting today.”
The four interventions studied included the following: Maximizing Independence at Home, an at-home, care coordination intervention that consists of care planning, skill-building, referrals to services and care monitoring; New York University Caregiver, which is implemented in an outpatient clinic and provides caregivers with six counseling sessions over four months plus lifetime ad-hoc support and access to weekly support groups; Alzheimer’s and Dementia Care, in which a health care system provides people living with dementia and their caregivers a needs assessment, individual care plans and round-the-clock access to a care manager; and Adult Day Service Plus, which augments adult day care services with staff providing face-to-face caregiver support, disease education, care management, skill-building and resource referrals.
Nonpharmacological interventions like these provide family caregivers with knowledge, skills and support tailored to their care challenges. They have been shown to improve quality of life for the caregiver and the person living with dementia, as well as to reduce nursing home admissions, and they are not associated with adverse events such as hospitalizations and mortality. For these reasons, nonpharmacological interventions are recommended as first-line therapies for the management of Alzheimer’s and dementia.
While non-drug interventions are well-studied, Jutkowitz said they haven't been widely implemented in clinical care centers. He added that there isn’t currently an infrastructure in place to support these methods of care — for example, there are limited mechanisms for providers to be reimbursed for these types of interventions.
To conduct the study, the researchers used a computer simulation to model the likelihood of nursing home admission for four evidence-based Alzheimer’s and dementia nonpharmacological interventions compared to usual care. For each, the study evaluated societal costs, quality-adjusted life-years and cost-effectiveness. The inputs in the simulation were based on data from Medicare, clinical trials and national surveys with families of people with dementia.
Jutkowitz noted that the researchers benefited not only from Brown University computing resources that could handle intensive analytic tasks, but also access to data from the government’s Centers for Medicare and Medicaid Services, which was crucial to the analysis.
In addition to finding that the interventions were cost-effective from a societal perspective, the researchers also found that from a health care payer perspective, the interventions involved little to no additional cost, compared to usual care, while increasing patient quality of life.
Based on the study findings, the authors concluded that health insurance policies should find ways to incentivize providers and health systems to implement nonpharmacological interventions.
The importance of understanding the cost-effectiveness of non-drug Alzheimer’s and dementia interventions is further highlighted by changes in Medicare payment models and emerging Alzheimer’s therapeutics, the researchers noted. The Centers for Medicare and Medicaid Services is in the process of determining coverage for new Alzheimer’s and related dementia drugs.
“As the Centers for Medicare and Medicaid Services determine coverage for new Alzheimer’s and related dementia drugs, we strongly believe that CMS should also consider the benefits of nonpharmacologic interventions,” Jutkowitz said.
While this study focused on non-drug interventions that reduce nursing home admissions, a future analysis will look at similar interventions that reduce or maintain functional decline and challenging behaviors. The researchers are also working on designing a trial that would test the interventions with patients in a health care setting.
Additional Brown contributors included Peter Shewmaker and Gary Epstein-Lubow.
This research was supported by the National Institute on Aging (1R21AG059623-01, 1R01AG060871-01, 1RF1AG069771, R01AG049692).
METHOD OF RESEARCH
Computational simulation/modeling
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Cost effectiveness of non-drug interventions that reduce nursing home admissions for people living with dementia
COI STATEMENT
Katherine M. Prioli conducted the research while at Rutgers University and is now an employee of OPEN Health. All authors report no conflicts of interest. Author disclosures are available in the supporting information.
Activating adult-born neurons through deep brain stimulation alleviates Alzheimer’s symptoms in rodent models
IMAGE: ACTIVATION OF HYPOTHALAMIC-ENHANCED ADULT-BORN NEURONS RESTORES COGNITIVE AND AFFECTIVE FUNCTION IN ALZHEIMER’S DISEASE view more
CREDIT: CELL STEM CELL/LI ET AL.
People with Alzheimer’s disease develop defects in cognitive functions like memory as well as problems with noncognitive functions that can lead to anxiety and depression. In a paper published April 6 in the journal Cell Stem Cell, investigators used mice to study a process through which new neurons are generated in adulthood, called adult hippocampus neurogenesis (AHN). The research showed that deep brain stimulation of new neurons helped restore both cognitive and noncognitive functions in mouse models of Alzheimer’s disease.
“We were surprised to find that activating only a small population of adult-born new neurons was enough to make a significant contribution to these brain functions,” says senior author Juan Song, an associate professor at the University of North Carolina at Chapel Hill. The neurons were modified by deep brain stimulation of the suprammamillary nucleus (SuM), which is located in the hypothalamus. “We are eager to find out the mechanisms that underlie these beneficial effects,” Song says.
This research used two distinct mouse models of Alzheimer’s. The investigators used optogenetics to stimulate the SuM and enhance AHN in Alzheimer’s mice. Their earlier research had shown that stimulation of the SuM could increase the production of new neurons and improve their qualities in normal adult mice. In the new study, the investigators showed that this strategy was also effective in the Alzheimer’s mice, leading to the generation of new neurons that made better connections with other parts of the brain.
However, having more improved new neurons is not enough to improve memory and mood. Behavioral improvement in Alzheimer’s mice were seen only when these improved new neurons were activated by chemogenetics. The researchers used memory tests as well as established assessments to look for anxiety-like and depression-like behavior to confirm these improvements. The results suggested that multi-level enhancement of new neurons—enhancement in number, properties, and activity—is required for behavioral restoration in Alzheimer's brains.
To further understand the mechanism, they also analyzed the protein changes in the hippocampus of Alzheimer’s mice in response to activation of SuM-modified adult-born new neurons. They found several well-known protein pathways activated inside cells, including those known to be important for improved memory performance, as well as those that allow clearance of the plaques related to Alzheimer’s.
“It was striking that multilevel enhancement of such a small number of adult-born new neurons made such a profound functional contribution to the animals’ diseased brains,” Song says. “We were also surprised to find that activation of SuM-enhanced neurons promoted the process that can potentially remove plaques.”
Future efforts of the team will focus on developing potential therapeutics that mimic the beneficial effects mediated by activation of SuM-modified new neurons. “We are hoping these drugs could exert therapeutic effects in patients with low or no hippocampal neurogenesis,” Song says. “Ultimately, the hope is to develop first-in-class, highly targeted therapies to treat Alzheimer’s and related dementia.”
###
This work was supported by the NIH, Alzheimer’s Association, Brain & Behavior Research Foundation, NIH- NINDS Neuroscience Center, NIH- NICHD Intellectual and Developmental Disabilities Research Center, and a UNC Pharmacology Curriculum predoctoral T32 training grant.
Cell Stem Cell, Li et al. “Activation of hypothalamic-enhanced adult-born neurons restores cognitive and affective function in Alzheimer’s disease” https://www.cell.com/cell-stem-cell/fulltext/S1934-5909(23)00043-7
Cell Stem Cell (@CellStemCell), published by Cell Press, is a monthly journal that publishes research reports describing novel results of unusual significance in all areas of stem cell research. Each issue also contains a wide variety of review and analysis articles covering topics relevant to stem cell research ranging from basic biological advances to ethical, policy, and funding issues. Visit: http://www.cell.com/cell-stem-cell. To receive Cell Press media alerts, contact press@cell.com.
JOURNAL
Cell Stem Cell
METHOD OF RESEARCH
Experimental study
SUBJECT OF RESEARCH
Animals
ARTICLE TITLE
Activation of hypothalamic-enhanced adult-born neurons restores cognitive and affective function in Alzheimer's disease
No comments:
Post a Comment