MEDICAL COSTS PRECEDING DIAGNOSIS OF PROBABLE ALZHEIMER-DISEASE

Alzheimer's disease (AD) has a significant social and economic impact on patients, their families and society as a whole. The diagnosis is d ifficult at the onset of symptoms, when the memory decline or a behavi oral changes are easily explained with stress or general age-related a sthenia, slowing down the correct diagnosis and often requires very ex pensive diagnostical examinations. The aim of this work was at evaluat ing the global price sustained by each patient before reaching the dia gnosis of probable AD, paid for examination, drugs and specialists con sultations because of the progressive cognitive and/or behavioral dise ases. Twenty patients were interviewed by a semi-structured method, in order to evaluate the clinical onset of the disease, the number of sp ecialists consulted before diagnosis of probable AD, the list of exami nations performed, the costs of examinations and drugs administered in this period. The mean delay between clinical onset and diagnosis of p robable AD was 30.7 +/- 32.7 months (SD). The clinical picture at onse t was dominated by behavioral disease in 66 % of cases and by cognitiv e symptoms in 34 % of cases. The patients consulted on average 2 speci alists before diagnosis. Five patients were affected also by other con comitant pathologies at the onset of cognitive decline and, for this r eason, these patients were visited and treated also by other specialis ts who made hypothesis or reaffirm the diagnostical course for a cogni tive decline. The examinations performed, suggested by the specialist, were: blood chemistry, computed tomography (CT) scans, ultrasonograph y of cervical arteries, magnetic resonance imagin electroencephalograp hy. single photon positron emission tomography. The mean cost sustaine d by each patient for examinations performed by the public health serv ice was about 112 US Dollars, while the mean cost sustained by each pa tient for examinations performed by private health service was about 4 02 Dollars. The specialists prescribed more often vitamins, nootropics and benzodiazepines. The most expensive drugs were the psychiatric dr ugs. The main price sustained for drugs was 505 +/- 233 Dollars. AD is a strongly devastating and expensive illness, and the magnitude of th e economic burden imposed by the disease on society will increase in t he coming years. Moreover, some examinations prescribed are often not helpful for the diagnosis. It is possible that the costs in the future may be influenced, among other things, by demographic changes, new th erapies and diagnostical examinations.