Previous trials reported that collaborative Dementia Care Management (cDCM) could be effective for patients and caregivers and cost-effective for healthcare systems in the short term. However, long-term evidence is lacking. Therefore, the study’s objective was to determine the long-term efficacy and cost-effectiveness of cDCM compared with usual care. A General Practitioner (GP)-based, cluster-randomized-controlled intervention trial (DelpHi-MV) was conducted. Participating GP practices were randomly allocated to one of two arms (care as usual or cDCM). Participants of the intervention group received a comprehensive needs assessment and individualized interventions by nurses specifically qualified for dementia collaborating with GPs and healthcare stakeholders over six months. Controls received usual care. Primary endpoints were behavioral and psychological symptoms (NPI), caregiver burden (Berlin Inventory of Caregivers' Burden), Health-Related Quality of Life (HRQoL, QoL-AD, SF-12), anti-dementia drug treatment, potentially inappropriate medication, and cost-effectiveness (incremental cost and Quality-adjusted Life Years, QALYs) after 36 months. 308 participants (n = 221 cDCM, n = 87 usual care) were included for the efficacy analyses, and 428 (n = 303 cDCM, n = 125 usual care) for the cost-effectiveness analysis that included deceased patients. Based on multivariate regression models adjusted for baseline scores, participants receiving cDCM showed significantly less behavioural and psychological symptoms (adjusted mean difference -10.3 [95% CI -16.9 to -3.6], p = 0.003, Cohens-d = -0.78), better mental health (+2.26 [0.3 to 4.2], p = 0.023, d = 0.26) and lower caregiver burden (-0.59 [-0.8 to -0.4], p<0.001, d = 0.71), and more likely received anti-dementia drugs (adjusted odds ratio 1.91 [1.0 to 3.8], p = 0.065, Cramérs-V = 0.12) compared to usual care participants. There was no effect on overall HRQoL, physical health, or potentially inappropriate medication after 36 months. cDCM gained QALYs (+0.14 [0.01 to 0.27], p = 0.050, d = 0.20) and increased costs (+437€ [-5,438 to 6,313], p = 0.868, d = 0.02), resulting in a cost-effectiveness-ratio of 3,186€/QALY. Cost-effectiveness was significantly better in PlwD living alone (-3,815€, +0.224 QALYs, cDCM dominates) compared to those living with a caregiver (+3.283€, +0.079 QALYs, 47,538€/QALY). cDCM is effective and cost-effective in the long term, improving patients, caregivers, and health system-relevant outcomes beyond the intervention or short-term periods, and, therefore, should become a health policy priority and translated into routine care practice.

Previous trials reported that collaborative Dementia Care Management (cDCM) could be cost-effective in the short term, especially for those living alone. However, long-term evidence is lacking. Therefore, the study’s objective was to determine the long-term efficacy and cost-effectiveness of cDCM in those living alone compared to those living with a caregiver. compared with usual care. A General Practitioner (GP)-based, cluster-randomized-controlled intervention trial (DelpHi-MV) was conducted. Participating GP practices were randomly allocated to one of two arms (care as usual or cDCM). Participants were included if they were 70 years or older, living at home, and screened positive for dementia. Participants of the intervention group received a comprehensive needs assessment and individualized interventions by nurses specifically qualified for dementia collaborating with GPs and healthcare stakeholders over six months. Controls received usual care. We conducted a subgroup analyses separating the sample into those living alone versus those living not alone. Health-Related Quality of Life (SF-6D), Quality-adjusted life years, and resource used were assessed at baseline, 12, 24 and 36 months. 428 (n = 303 cDCM, n = 125 usual care) participants were included in the analysis. Based on multivariate regression models adjusted for baseline scores, cDCM was more cost-effective in PlwD living alone. Compared to controls, the gain in QALY (alone: +0.224 [95% CI 0.03 to 0.42], p = 0.027; not alone: 0.079 [95% CI -0.11 to 0.27], p<0.417), savings in costs (alone: -3,815 [-12,573 to 5,982], p = 0.485; not alone: 3,283 [-3,514 to 11,121], p = 0.307), and the probability of cost-effectiveness at WTP 40.000€/QALY was significantly higher in PlwD living alone (92% vs 32%). Differences in costs were especially due to a trend for delayed institutionalization in the first and second year for those living alone. cDCM is cost-effective in the long term beyond the intervention or short-term periods, improving patients HRQoL and reducing costs in those living alone. Therefore, should become a health policy priority and translated into routine care practice. Whether cDCM more likely leads to better-prepared institutionalization should be investigated in future research to support the community-dwelling living situation as long as possible and make institutionalizations as smooth as possible.

Background and Objectives:Depressive symptoms are common in people with dementia, significantly reducing well-being and potentially exacerbating dementia symptoms. The objective of the present study was to investigate the role of support from the social environment for depressive symptoms in people with dementia over a 4-year period. Research Design and Methods:We used data from a cohort of 334 community-dwelling people with dementia (M age = 80.2, 59.3% female) who were interviewed annually in their homes by specially qualified nurses. We used multilevel growth curve models with random intercepts and slopes to model depressive symptoms over time. We modeled both the role of between-person differences and the role of within-person changes in social support for depressive symptoms. Results:At the beginning of the study, 13.8% of people with dementia reported mild to severe depressive symptoms. People with more social support showed fewer depressive symptoms overall over the 4-year period (% change per point on a scale from 22 to 110: -1.2, 95% CI: -1.8, -0.4). In addition, a decline in a person's social support was associated with more depressive symptoms (% change: -0.9, 95% CI: -1.7, -0.2). These effects were stable even after controlling for sociodemographic (age, sex, education) and clinical factors (cognitive and functional status, comorbidities). Discussion and Implications:The social environment plays an important role in depressive symptoms in people with dementia-beyond clinical factors like cognitive and functional abilities. Improving support from the social environment could be a lever for alleviating depressive symptoms. In the care of people with dementia, not only medical needs but also psychosocial needs should come to the forefront.

INTRODUCTION:This study investigated the association between modifiable factors and symptom progression in dementia over up to 8 years. METHODS:Multilevel growth curve models assessed the role of modifiable risk factors (low education, hearing impairment and its treatment, depression, physical inactivity, diabetes and its treatment, smoking, hypertension and its treatment, obesity, alcohol consumption, social isolation, and visual impairment) on cognitive and functional trajectories in 353 people with dementia. RESULTS:Higher education was associated with higher initial cognitive status but faster decline. Antidiabetic medication was associated with slower cognitive decline, whereas depression and visual impairment were linked to low baseline functioning and faster cognitive decline. DISCUSSION:Several modifiable risk factors influenced symptom progression. Education initially had a protective effect, whereas depressive symptoms were linked to worse symptom progression. Treatment of comorbidities (diabetes, visual impairment) could have a positive impact on dementia symptoms. Modifiable risk factors are promising targets for tertiary prevention. Highlights:Modifiable risk factors were associated with symptom progression in dementia over up to 8 years.More education was associated with higher initial cognitive status but faster decline.Depressive symptoms were linked to less favorable symptom progression.Treatment of comorbidities (diabetes, visual impairment) may positively impact the course of symptoms.Modifiable risk factors are promising targets for tertiary prevention.

Taking care of a person with dementia is challenging and can contribute to depressive symptoms in caregivers. To provide tailored support, predictors of depressive symptoms need to be better understood. Yet, there is a lack of longitudinal studies and little knowledge about the role of psychosocial factors. To address this gap, this study investigates the role of perceived lack of appreciation as well as perceived burden of losing the relationship to the person with dementia on depressive symptoms in caregivers longitudinally – beyond known demographic and clinical predictors. We analyzed data from 179 dyads consisting of people with dementia (Mage = 80, 61.5% female) and their caregivers (Mage = 64.5, 70.9% female) in Germany. Dyads were interviewed annually by specially qualified nurses over a time span of four years. Depressive symptoms of caregivers were assessed with the Patient Health Questionnaire (PHQ), psychosocial factors were assessed using the Berlin Inventory of Caregiver Burden (BIZA-D). We employed a multilevel growth curve model with random intercepts and slopes. We investigated the role of both within- and between-person differences in psychosocial factors for depressive symptoms in caregivers. Perceived lack of appreciation and the perceived burden of losing the relationship to the person with dementia were significant both as within- and between-person differences. The severity of cognitive symptoms in the person with dementia was significant as between- but not within-person difference. Neuropsychiatric symptoms were significant as within- but not between-person difference. For the first time, this study indicates that psychosocial factors play an important role in the development of depressive symptoms in caregivers of people with dementia. Appreciation by the social environment and addressing the changing relationship between the caregiver and the person with dementia might be promising targets for interventions.

Subjective aging predicts various developmental outcomes, including cognitive functioning. However, associations could be bidirectional. We focused on central dimensions of subjective aging (subjective age; self-perceptions of aging related to social losses, physical losses, and ongoing development) and investigated reciprocal longitudinal associations with perceptual-motor speed, both at the between-person level (i.e., Do individuals with more positive subjective aging trajectories exhibit better cognitive performance trajectories?) and within-person level (e.g., Is an individuals' cognitive performance poorer than their typical trajectory on measurement occasions when their subjective aging is less positive than their typical trajectory?). We used data from the German Ageing Survey (n = 15,898; aged 40-95 years; observation period: 2002-2017, up to five occasions; mean number of observations: 2.1; sample sizes between 2002 and 2017: 4,334; 7,668; 4,800; 9,703; 6,551). Using autoregressive latent trajectory models with structured residuals, we controlled for sociodemographic, social, and health-related factors. At the between-person level, higher levels of perceptions related to ongoing development and lower levels of perceptions related to physical and social loss were associated with higher levels of perceptual-motor speed. Linear decline in perceptual-motor speed was less steep for individuals with lower physical loss intercepts and higher ongoing development levels. While there were significant within-person synchronous associations between perceptual-motor speed and subjective aging, we found no reliable cross-lagged associations. All between-person and within-person associations of subjective age with perceptual-motor speed were not statistically significant. Our results imply that there are meaningful between-person and within-person associations between subjective aging and cognitive abilities. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Background The use of unsupervised digital cognitive assessments provides considerable opportunities for early and comprehensive testing for Alzheimer disease, minimizing the demand on time and personnel resources in medical practices. However, the acceptance within health care has yet to be assessed. Objective In this implementation study, the acceptance of an app-based, repeated cognitive assessment for early symptoms of Alzheimer disease in the outpatient care setting from both physicians’ and patients’ perspectives was examined. Methods In total, 15 primary care practices participated, where patients with self- or relative-reported memory problems could be prescribed an app (neotivCare app [neotiv GmbH]) for comprehensive cognitive testing. Patients used the app to test their episodic memory function weekly for 12 weeks at home. After the testing period and the final consultation, physicians and patients received questionnaires to assess the app’s acceptance. Results We received completed questionnaires from physicians for 45 patients. In addition, we received 45 completed questionnaires from the patients themselves. The physicians reported that, for most patients, the app supported their decision-making in the diagnostic process (26/45, 58%). In addition, most physicians found the app’s information dependable (34/45, 76%) and felt more certain in their decisions (38/45, 84%). From the patients’ perspective, a majority felt thoroughly tested (34/45, 76%), and only a few considered the time commitment for the cognitive tests to be too burdensome (7/45, 16%). Furthermore, despite the weekly cognitive testing and the lengthy 12-week testing period, a majority of patients participated in all tests (39/54, 72%). Conclusions Our results indicate a high level of acceptance by physicians and patients, suggesting significant potential for the implementation of unsupervised digital cognitive assessments into routine health care. In the future, acceptance should be assessed in large-scale studies, with a particular focus on the impact on health care delivery and patient outcomes.

Depressive symptoms are a common neuropsychological symptom in people with dementia. They are associated with reduced well-being and may exacerbate dementia symptoms. So far, there has been little research on how modifiable factors, such as the social environment, are associated with the severity of symptoms. The aim of the present study was to investigate the role of support from the social environment for depressive symptoms in community-dwelling people with dementia – beyond sociodemographic and clinical factors. We used data from 378 people screened positive for dementia in primary care (Mage = 80.2, 59.5% female) who were interviewed annually in their homes by specially qualified nurses. Social support was assessed using the Questionnaire for the Assessment of Social Support (FSozU), depressive symptoms were measured using the Geriatric Depression Scale (GDS). We used multilevel growth curve models with random intercepts and slopes to model depressive symptoms over time. We modelled both the role of between-person differences and the role of within-person changes in social support for depressive symptoms. At the beginning of the study, the number of people with dementia who reported mild to severe depressive symptoms was 15.6 %. More social support was associated with fewer depressive symptoms overall over the four-year period (blog = -0.27, % change: -23.66, 95% CI: -32.29, -13.93). A decline in social support was associated with more depressive symptoms (blog = -0.23, % change: -20.55, 95% CI: -28.82, -12.19). These effects remained stable after controlling for sociodemographic and clinical factors. This is the first study to show that the social environment plays an important role in depressive symptoms in people with dementia – above and beyond clinical factors. Social support as a modifiable factor may be a lever for alleviating depressive symptoms in dementia. In the care of people with dementia, not only medical but also psychosocial needs should be given greater attention.

Objectives The aim of the present study was to examine the reliability and validity (structural and convergent) of the Resilience and Strain Questionnaire in Caregivers of People with Dementia (ResQ-Care-Dem).Design Cross-sectional survey study.Setting Online survey in Germany.Participants The ResQ-Care-Dem was completed by 243 informal caregivers of people with dementia (Mage=59.7 years, SD=10.9, 84.8% female).Methods The ResQ-Care-Dem consists of four scales: two resilience scales (psychological aspects and social aspects of resilience) and two burden scales (interpersonal burden and general burden). The reliability of the two resilience and two burden scales was assessed using Cronbach’s alpha as a measure of internal consistency. Structural validity was examined using a principal axis factor analysis. Convergent validity was assessed by Pearson’s correlations with the Zarit Burden Interview (ZBI-7), the Caregiver Self-Efficacy Scale (CES-8) and the Gain in Alzheimer Care Instrument (GAIN).Results The ResQ-Care-Dem scales’ internal consistencies ranged between 0.65 and 0.81. The factorial structure could partly be confirmed, with the items of the four scales primarily loading on four factors. The burden scales demonstrated high and positive correlations with the score for caregiver burden (ZBI-7, r=0.51 – 0.55) and small to high, negative correlations with the scores for caregiver self-efficacy (CES-8, r=–0.52 –0.56) and gains from caregiving (GAIN, r=−0.21 −0.22), supporting construct validity of the scales. The resilience scales showed small to high positive correlations with the scores for caregiver self-efficacy (CES-8, r=0.50 – 0.57) and gains from caregiving (GAIN, r=0.27 – 0.50), as well as moderate negative correlations with the caregiver burden score (ZBI-7, r=−0.45 −0.50), providing evidence for the scales’ construct validity.Conclusions The reliability and structural validity of the ResQ-Care-Dem were partially confirmed. Evidence supporting its convergent validity suggests that the questionnaire has potential as a tool for assessing caregiver burden and resilience factors among informal caregivers of people with dementia. While these findings indicate potential practical applicability, future studies should investigate its performance in real-world settings and assess changes over time (eg, responsiveness) in longitudinal studies.

Due to limited treatment options, managing symptoms has dominated care for Spinocerebellar Ataxia (SCA). Little attention has been given to health-related quality of life (HRQoL) and depressive symptoms experienced by patients across disease duration. To investigate the course of HRQoL and the severity of depressive symptoms in SCA from disease onset to 26 years after onset and identify influencing factors. We analyzed data from two longitudinal SCA cohorts, the EUROSCA (European Spinocerebellar Ataxia Registry) and ESMI study (European Spinocerebellar Ataxia Type 3/Machado-Joseph Disease Initiative). Multilevel mixed-effects models were employed to demonstrate the course of HRQoL and depressive symptoms severity to investigate the role of disease progression with disease duration as a predictor of interest, along with time-varying clinical variables and time-fixed covariates. Seven hundred seventy four participants (Mage = 50.8 ± 13.4; 48.6

This study examined the relationship between healthcare utilization and support related factors, such as social support and marital status, in patients with dementia (PwD) over 5 years. We analysed data from 498 participants in the GP-based randomized controlled intervention trial DelpHi-MV (dementia: life- and person-centred help in Mecklenburg-Western Pomerania, Germany). Negative binomial regression was used to model GP and internist visits, while zero-inflated negative binomial regression analysed dentist and neurologist/psychiatrist visits, with predictors including social support and sociodemographic variables. Participants had a mean age of 80.1 years (SD = 5.45), with 59.6% female and 43.7% married. Emotional support (β = 0.23, SE = 0.04, p  < 0.0001), social integration (β = -0.10, SE = 0.03, p  = 0.003), and marital status (divorcés: β = 0.24, SE = 0.07, p  < 0.0001; widowers: β = 0.08, SE = 0.04, p  = 0.03) were associated with GP visits. Practical support was positively associated with dentist visits (b = 0.27, SE = 0.06, p  < 0.0001). Social integration (b = 0.21, SE = 0.08, p  = 0.03) and marital status (singles: b = 1.42, SE = 0.24, p  < 0.0001) emerged as significant predictors for neurologist/psychiatrist visits. Our findings highlight the importance of social support, including emotional and practical support, social integration, and marital status, as key predictors of healthcare utilization in PwD. These results underscore the need for tailored interventions to address social and demographic disparities in dementia care.

BackgroundHealthy dietary patterns have been linked to reduced risks for cardiovascular diseases and dementia, making nutrition an essential part of a comprehensive approach for dementia prevention. Knowledge about factors associated with a healthy diet in people with increased dementia risk is scarce.ObjectiveTo analyze dietary habits and associated factors in older adults with increased dementia risk in Germany.MethodsWe used baseline-data of the AgeWell.de-trial (n = 1001, %female = 52.2, Mage = 69.0, SD = 4.9). Nutrition was assessed using a composite score, comprising 11 components covered by national recommendations for a healthy diet (range = 0-11 points). Linear regressions assessed associations of sociodemographic, social, health-related and psychological factors with consumption of a healthy diet. Further, we assessed stages of change based on the transtheoretical model of behavior change.ResultsConsumption of a healthy diet was moderate (Median = 4, IQR = 2). Female sex (b = 0.64, 95% CI: 0.41, 0.88), higher levels of motivation for healthy eating (b = 0.22, 95% CI: 0.10, 0.34) and higher self-efficacy (b = 0.33, 95% CI: 0.20, 0.46) were linked to a healthy diet. Regarding the stages of behavior change, the majority were in the maintenance stage (45.2%), followed by the contemplation (21.5%) and precontemplation (21.2%) stages.ConclusionsResults suggest room for improvement regarding a healthy diet in our sample. Lifestyle-based interventions in older adults should be tailored towards current levels of motivation and self-efficacy of participants. Including modules targeting motivation and self-efficacy might help maximize intervention effectiveness.

The aim of the present study was twofold: First, to examine the validity of previously reported sociodemographic (age, sex) and clinical predictors (cognitive status, functional status, comorbidities) for the life expectancy in people with dementia in a community sample. Second, to investigate the role of social support beyond individual predictors. The study utilizes data from 500 individuals living in the community who were diagnosed with dementia. These participants were monitored over a period of up to eight years. The research focused on assessing life expectancy in connection with established sociodemographic factors (such as age and sex), clinical predictors (including cognitive status, functional status, and comorbidities), and also considered the impact of social support. This was analyzed using Cox regression. Advanced age increased the risk of mortality (hazard ratio [HR], 1.08; 95% CI, 1.05–1.11), while being female was associated with a lower mortality risk (HR, 0.65; 95% CI, 0.49–0.87). Higher cognitive (HR, 0.95; 95% CI, 0.93–0.98) and functional status at baseline (HR, 0.91; 95% CI, 0.86–0.97) were linked to increased life expectancy. Greater support from the social environment reduced the risk of mortality (HR, 0.79; 95% CI, 0.64–0.99), even after accounting for clinical variables. Previously reported sociodemographic and clinical predictors were confirmed within a community sample. Additionally, social support was found to predict life expectancy in individuals with dementia. Our findings highlight the crucial role of the social environment for the well-being of individuals with dementia and emphasise the need for interventions that specifically address these factors.

BACKGROUND:The aim of the present study was to investigate the association between modifiable factors and symptom progression in people with dementia over a period of up to eight years. METHOD:We used data from a German cohort of community-dwelling individuals who screened positive for dementia in primary care. They underwent comprehensive annual in-home-assessments for up to eight years by specially trained nurses. The following modifiable factors were considered: low education, hearing impairment (and its treatment), hypertension (and its treatment), alcohol consumption, obesity, smoking, depression, social isolation, physical inactivity, diabetes (and its treatment) and visual impairment. We used multilevel growth curve models to investigate the role of modifiable risk factors on cognitive trajectories and trajectories in daily functioning. RESULT:Higher education was associated with higher cognitive status at the beginning of the study, but also with faster cognitive decline over time. People receiving anti-diabetic medications showed slower cognitive decline, while depression and visual impairment were associated with lower levels of daily functioning at baseline and faster cognitive decline over the eight-year study period. We found no association of hearing impairment (or its treatment), hypertension (or its treatment), alcohol consumption, obesity, smoking, lack of social support and physical inactivity with the rate of symptom progression. CONCLUSION:Our study found evidence that several potentially modifiable risk factors influenced symptom progression in dementia over up to eight years. Cognitive reserve through education showed a positive effect, which reversed over time, and depressive symptoms were linked to less favorable progression. Treating comorbidities like diabetes and visual impairment may positively impact dementia symptoms. Modifiable risk factors are promising targets for tertiary prevention and should be explored further.

Approximately 1.8 million individuals in Germany live with dementia, imposing a substantial burden on family caregivers who provide most care and often experience health issues, social isolation, and diminished quality of life. Recognizing and addressing the diverse needs of these caregivers is vital for their well-being and the stability of care arrangements. This study employed a longitudinal, cluster-randomized controlled trial in Mecklenburg-Western Pomerania, Germany, with 192 informal caregivers of people living with dementia. Participants were randomly assigned to either the control (n = 96) or intervention (n = 96) group. The intervention involved a digitally supported care management program delivered by trained care managers, specifically tailored to address the unmet needs of caregivers. Primary outcomes after 6 months included the number of unmet needs and the health-related quality of life of caregivers. Secondary outcomes comprised caregiver burden and social network/support. While the intervention did not significantly reduce overall unmet needs in multivariate models, it demonstrated a notable effect in the subgroup of younger family caregivers. No statistically significant impacts were observed on other outcomes. Individualized care management, as delivered through this program, effectively addresses the specific support needs of informal caregivers. The study emphasizes the importance of tailoring interventions to sustain preferred caregiving arrangements and underscores the necessity of investigating nuanced needs for effective support. Although the program did not show a universal reduction in unmet needs, its positive impact on younger caregivers suggests potential benefits for specific demographic groups.

INTRODUCTION:Effective dementia prevention requires understanding the distribution of modifiable risk factors and identifying high-risk subgroups. We estimated the prevention potential in Germany and identified risk profiles to inform precision public health. METHODS:We analyzed nationally representative data from the 2023 German Aging Survey (n = 4992). Population attributable fractions and potential impact fractions were computed for established modifiable risk factors. Relative risks were taken from meta-analyses. Latent class analysis identified risk profiles. RESULTS:An estimated 36% of dementia cases in Germany are attributable to modifiable risk factors. Reducing their prevalence by 15%-30% could prevent 170,000-330,000 cases by 2050. We identified four risk profiles-metabolic, sensory impairment, alcohol, and lower-risk-each associated with demographic and regional characteristics. DISCUSSION:Our findings highlight considerable national prevention potential and reveal population subgroups with shared risk patterns. These profiles provide a foundation for designing targeted, equitable, and efficient dementia prevention strategies. Highlights:36% of dementia cases in Germany are linked to modifiable risk factors.A 15% reduction in risk factor prevalence could prevent 170,000 cases by 2050.Key contributors: depression, hearing loss, low education, and obesity.Data-driven risk profiles identified (e.g., metabolic, sensory, low-risk).Risk profiles strongly associated with sociodemographic characteristics.

OBJECTIVES:To examine the cost-effectiveness of a digitally supported care management system (CMS) for caregivers of people with dementia (PwD) compared with usual care. METHODS:The analysis was based on 192 caregivers (n = 96 CMS, n = 96 usual care) of PwD in a cluster-randomized controlled trial testing a digitally supported CMS, aiming to identify and address caregivers' unmet needs and develop and implement an individualized support and care plan over 6 months. Incremental costs from the public-payer and societal perspectives, quality-adjusted life years (QALY), and the incremental cost-effectiveness ratio 6 months after baseline were calculated using multivariate regression models. We assessed the probability of cost-effectiveness using a range of willingness-to-pay thresholds. RESULTS:Caregivers in the intervention group gained QALYs (+0.004 [95% CI -0.003 to 0.012], P value = .225) and had lower costs from the public payer (-378€ [1926-1168], P value = .630), but higher costs from the societal perspective (+1324 [-3634 to 6284], P value = .599). The intervention dominated usual care from the payer perspective, whereas the incremental cost-effectiveness ratio was €331 000/QALY from a societal perspective. The probability of cost-effectiveness was 72% and 79% from the public payer and 33% and 35% from a societal perspective at the willingness-to-pay thresholds threshold of €40 000 and €80 000/QALY gained. CONCLUSIONS:CMS was likely cost-effective from the payer but not from a societal perspective, underlining the importance of informal care. The gain in QALY was marginal and could be due to the short observation period. Focusing on both the caregiver and the PwD, rather than assessing the PwD needs through the caregiver, could improve the cost-effectiveness results.

The aim of the present study was to investigate the association between modifiable factors and symptom progression in people with dementia over a period of up to eight years. We used data from a German cohort of community-dwelling individuals who screened positive for dementia in primary care. They underwent comprehensive annual in-home-assessments for up to eight years by specially trained nurses. The following modifiable factors were considered: low education, hearing impairment (and its treatment), hypertension (and its treatment), alcohol consumption, obesity, smoking, depression, social isolation, physical inactivity, diabetes (and its treatment) and visual impairment. We used multilevel growth curve models to investigate the role of modifiable risk factors on cognitive trajectories and trajectories in daily functioning. Higher education was associated with higher cognitive status at the beginning of the study, but also with faster cognitive decline over time. People receiving anti-diabetic medications showed slower cognitive decline, while depression and visual impairment were associated with lower levels of daily functioning at baseline and faster cognitive decline over the eight-year study period. We found no association of hearing impairment (or its treatment), hypertension (or its treatment), alcohol consumption, obesity, smoking, lack of social support and physical inactivity with the rate of symptom progression. Our study found evidence that several potentially modifiable risk factors influenced symptom progression in dementia over up to eight years. Cognitive reserve through education showed a positive effect, which reversed over time, and depressive symptoms were linked to less favorable progression. Treating comorbidities like diabetes and visual impairment may positively impact dementia symptoms. Modifiable risk factors are promising targets for tertiary prevention and should be explored further.

BACKGROUND:The aim of this study was to investigate the role of support from the social environment for the life expectancy in people with dementia beyond well-established individual demographic and clinical predictors over a period of up to 8 years. METHODS:The analyses are based on data from 500 community-dwelling individuals in Germany who tested positive for dementia and were followed up for up to 8 years. Life expectancy was examined in relation to perceived social support as well as well-established socio-demographic (age, sex) and clinical predictors (cognitive status, functional status, comorbidities), using Cox regressions. RESULTS:Greater support from the social environment reduced the risk of mortality (hazard ratio [HR]: 0.78; 95% confidence interval [CI]: 0.63-0.98), with the role of emotional support being particularly important. Furthermore, higher age was associated with an increased mortality risk (HR: 1.08; 95% CI: 1.05-1.11), while female sex (HR: 0.64; 95% CI: 0.48-0.85) and higher cognitive (HR: 0.96; 95% CI: 0.93-0.98) and functional status (HR: 0.91; 95% CI: 0.86-0.97) were associated with higher life expectancy. CONCLUSION:Our study provides novel evidence that less support from the social environment, especially emotional support, is a risk factor for shorter life expectancy in people with dementia-beyond known clinical factors. Not only the clinical and caregiving needs but also their psychosocial needs of individuals with dementia should be emphasised.

Importance:Long-term evidence for the effectiveness and cost-effectiveness of collaborative dementia care management (CDCM) is lacking. Objective:To evaluate whether 6 months of CDCM is associated with improved patient clinical outcomes and caregiver burden and is cost-effective compared with usual care over 36 months. Design, Setting, and Participants:This was a prespecified secondary analysis of a general practitioner (GP)-based, cluster randomized, 2-arm clinical trial conducted in Germany from January 1, 2012, to December 31, 2014, with follow-up until March 31, 2018. Participants were aged 70 years or older, lived at home, and screened positive for dementia. Data were analyzed from March 2011 to March 2018. Intervention:The intervention group received CDCM, comprising a comprehensive needs assessment and individualized interventions by nurses specifically qualified for dementia care collaborating with GPs and health care stakeholders over 6 months. The control group received usual care. Main Outcomes and Measures:Main outcomes were neuropsychiatric symptoms (Neuropsychiatric Inventory [NPI]), caregiver burden (Berlin Inventory of Caregivers' Burden in Dementia [BIZA-D]), health-related quality of life (HRQOL, measured by the Quality of Life in Alzheimer Disease scale and 12-Item Short-Form Health Survey [SF-12]), antidementia drug treatment, potentially inappropriate medication, and cost-effectiveness (incremental cost per quality-adjusted life year [QALY]) over 36 months. Outcomes between groups were compared using multivariate regression models adjusted for baseline scores. Results:A total of 308 patients, of whom 221 (71.8%) received CDCM (mean [SD] age, 80.1 [5.3] years; 142 [64.3%] women) and 87 (28.2%) received usual care (mean [SD] age, 79.2 [4.5] years; 50 [57.5%] women), were included in the clinical effectiveness analyses, and 428 (303 [70.8%] CDCM, 125 [29.2%] usual care) were included in the cost-effectiveness analysis (which included 120 patients who had died). Participants receiving CDCM showed significantly fewer behavioral and psychological symptoms (adjusted mean difference [AMD] in NPI score, -10.26 [95% CI, -16.95 to -3.58]; P = .003; Cohen d, -0.78 [95% CI, -1.09 to -0.46]), better mental health (AMD in SF-12 Mental Component Summary score, 2.26 [95% CI, 0.31-4.21]; P = .02; Cohen d, 0.26 [95% CI, -0.11 to 0.51]), and lower caregiver burden (AMD in BIZA-D score, -0.59 [95% CI, -0.81 to -0.37]; P < .001; Cohen d, -0.71 [95% CI, -1.03 to -0.40]). There was no difference between the CDCM group and usual care group in use of antidementia drugs (adjusted odds ratio, 1.91 [95% CI, 0.96-3.77]; P = .07; Cramér V, 0.12) after 36 months. There was no association with overall HRQOL, physical health, or use of potentially inappropriate medication. The CDCM group gained QALYs (0.137 [95% CI, 0.000 to 0.274]; P = .049; Cohen d, 0.20 [95% CI, -0.09 to 0.40]) but had no significant increase in costs (437€ [-5438€ to 6313€] [US $476 (95% CI, -$5927 to $6881)]; P = .87; Cohen d, 0.07 [95% CI, -0.14 to 0.28]), resulting in a cost-effectiveness ratio of 3186€ (US $3472) per QALY. Cost-effectiveness was significantly better for patients living alone (CDCM dominated, with lower costs and more QALYs gained) than for those living with a caregiver (47 538€ [US $51 816] per QALY). Conclusions and Relevance:In this secondary analysis of a cluster randomized clinical trial, CDCM was associated with improved patient, caregiver, and health system-relevant outcomes over 36 months beyond the intervention period. Therefore, it should become a health policy priority to initiate translation of CDCM into routine care. Trial Registration:ClinicalTrials.gov Identifier: NCT01401582.