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Longitudinal Impact of Agitation and Aggression Symptoms on Societal Costs in Alzheimer's Disease: A Focus on Informal Care and Socioeconomic Disparities.

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Τίτλος: Longitudinal Impact of Agitation and Aggression Symptoms on Societal Costs in Alzheimer's Disease: A Focus on Informal Care and Socioeconomic Disparities.
Συγγραφείς: Costa N; Health Economic Unit, Toulouse University Hospital, Toulouse, France.; CERPOP, Inserm, Toulouse, France., Marcélo Fleuret C; Health Economic Unit, Toulouse University Hospital, Toulouse, France., Gombault E; Health Economic Unit, Toulouse University Hospital, Toulouse, France.; University of Toulouse III, UPS, Toulouse, France., Soto Martin M; CERPOP, Inserm, Toulouse, France.; University of Toulouse III, UPS, Toulouse, France.; Department of Geriatric Medicine, Toulouse University Hospital, Toulouse, France., De Mauleon A; CERPOP, Inserm, Toulouse, France.; University of Toulouse III, UPS, Toulouse, France.; Department of Geriatric Medicine, Toulouse University Hospital, Toulouse, France.
Πηγή: International journal of geriatric psychiatry [Int J Geriatr Psychiatry] 2026 Oct; Vol. 41 (10), pp. e70257.
Τύπος έκδοσης: Journal Article; Multicenter Study; Observational Study
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: John Wiley Country of Publication: England NLM ID: 8710629 Publication Model: Print Cited Medium: Internet ISSN: 1099-1166 (Electronic) Linking ISSN: 08856230 NLM ISO Abbreviation: Int J Geriatr Psychiatry Subsets: MEDLINE
Imprint Name(s): Publication: Chichester : John Wiley
Original Publication: Chichester, Sussex, England ; [New York] : Wiley, c1986-
Ιατρικοί όροι (MeSH): Alzheimer Disease*/economics , Alzheimer Disease*/psychology , Psychomotor Agitation*/economics , Aggression*/psychology , Health Care Costs*/statistics & numerical data , Patient Care*/economics , Cost of Illness*, Caregivers/economics ; Long-Term Care/economics ; Humans ; Female ; Male ; Aged ; France ; Longitudinal Studies ; Prospective Studies ; Aged, 80 and over ; Middle Aged ; Socioeconomic Disparities in Health
Περίληψη: Background: To date, no longitudinal study has assessed the effect of agitation on societal costs-particularly informal care costs-over time in Alzheimer's Disease (AD) patients with Agitation and Aggression (A/A) symptoms.
Objectives: This study estimates the impact of A/A symptoms evolution on longitudinal care costs including informal care costs in moderate-to-severe AD, considering patient and caregiver socioeconomic characteristics.
Design: A longitudinal trajectory clustering method was used on this longitudinal, prospective, multicenter observational cohort study.
Setting and Participants: 262 community-dwelling and long-term care facility (LTCF) patients of both sexes, aged 60 years and older, with clinically significant A/A symptoms were recruited from memory centers in southwest France.
Methods: Patients were followed for 12 months. A/A data was recorded by clinicians using the Neuropsychiatric Inventory (NPI-c). Costs were estimated from a societal perspective, including healthcare and informal care, using the RUD questionnaire. K-means longitudinal method identified A/A evolution profiles. Cost differences across A/A evolution profiles were analyzed using Generalized Linear Models.
Results: Two A/A evolution profiles were identified: mild symptoms at baseline with improvement (A) and moderate symptoms at baseline with limited improvement or stability (B). Annual costs were €22,959 in group A and €23,625 in group B excluding supervision, and €52,111 and €56,149, respectively, including supervision. In LTCF residents, higher A/A severity was associated with increased medical visits and medication costs, though overall cost differences were smaller. Informal care neared 70% of total costs for community-dwelling patients, with supervision covering the majority of these costs.
Conclusions: Evolution of A/A symptoms significantly increases both healthcare and informal care costs, particularly in at-home settings. Integrating systematic monitoring of behavioral symptoms into routine care would enable personalized, cost-effective strategies. Informal care costs, often undervalued and overlooked in economic analyzes, underscores the need for improvement in resource allocation and quality of life, for both patients and caregivers.
Clinical Trial Number: NCT03554226.
(© 2026 The Author(s). International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.)
References: Rev Epidemiol Sante Publique. 2017 Oct;65 Suppl 4:S149-S167. (PMID: 28756037)
J Alzheimers Dis. 2021;83(1):89-101. (PMID: 34250934)
Struct Equ Modeling. 2014;21(2):263-279. (PMID: 24729675)
Geriatr Nurs. 2010 Jul-Aug;31(4):246-53. (PMID: 20682402)
J Am Med Dir Assoc. 2018 Jan;19(1):95.e1-95.e10. (PMID: 29275939)
J Am Geriatr Soc. 2006 May;54(5):796-803. (PMID: 16696746)
Neurodegener Dis. 2017;17(4-5):127-134. (PMID: 28245482)
Med Care. 2016 Feb;54(2):188-94. (PMID: 26683778)
Neuropsychiatr Dis Treat. 2019 Jul 17;15:2027-2034. (PMID: 31413574)
Int J Epidemiol. 2017 Apr 1;46(2):392-392d. (PMID: 28168290)
Alzheimers Dement (N Y). 2019 Nov 23;5:851-861. (PMID: 31799369)
Int Psychogeriatr. 2010 Sep;22(6):984-94. (PMID: 20594384)
Health Policy. 2014 May;116(1):114-22. (PMID: 24461717)
BMJ Open. 2015 Mar 13;5(3):e007382. (PMID: 25770235)
Comput Methods Programs Biomed. 2011 Dec;104(3):e112-21. (PMID: 21708413)
Eur J Health Econ. 2024 Apr;25(3):497-511. (PMID: 37296350)
Stat Med. 2004 Apr 30;23(8):1311-31. (PMID: 15083485)
Int Psychogeriatr. 2015 Jan;27(1):7-17. (PMID: 25311499)
J Prev Alzheimers Dis. 2021;8(2):199-209. (PMID: 33569568)
Eur J Ageing. 2016;13:271-279. (PMID: 27610055)
J Alzheimers Dis. 2022;89(1):359-366. (PMID: 35871348)
Biomed Res Int. 2013;2013:852368. (PMID: 23509789)
Alzheimers Dement. 2021 Oct;17(10):1687-1697. (PMID: 34132461)
Eur J Health Econ. 2004 Feb;5(1):36-45. (PMID: 15452763)
J Biomed Inform. 2023 Aug;144:104440. (PMID: 37429511)
Pharmacoeconomics. 2021 Nov;39(11):1209-1223. (PMID: 34324174)
JAMA Psychiatry. 2018 Jul 1;75(7):723-732. (PMID: 29799983)
Int Psychogeriatr. 2017 Oct;29(10):1723-1733. (PMID: 28625207)
Grant Information: Ethypharm; Center Hospitalier Universitaire de Toulouse
Contributed Indexing: Keywords: agitation/aggression; dementia; health care costs; informal care; longitudinal k‐means clustering; socioeconomic factors
Molecular Sequence: ClinicalTrials.gov NCT03554226
Entry Date(s): Date Created: 20261001 Date Completed: 20261001 Latest Revision: 20261005
Update Code: 20261006
PubMed Central ID: PMC13630399
DOI: 10.1002/gps.70257
PMID: 42821808
Βάση Δεδομένων: MEDLINE
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  Data: Longitudinal Impact of Agitation and Aggression Symptoms on Societal Costs in Alzheimer's Disease: A Focus on Informal Care and Socioeconomic Disparities.
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  Data: <searchLink fieldCode="AU" term="%22Costa+N%22">Costa N</searchLink>; Health Economic Unit, Toulouse University Hospital, Toulouse, France.; CERPOP, Inserm, Toulouse, France.<br /><searchLink fieldCode="AU" term="%22Marcélo+Fleuret+C%22">Marcélo Fleuret C</searchLink>; Health Economic Unit, Toulouse University Hospital, Toulouse, France.<br /><searchLink fieldCode="AU" term="%22Gombault+E%22">Gombault E</searchLink>; Health Economic Unit, Toulouse University Hospital, Toulouse, France.; University of Toulouse III, UPS, Toulouse, France.<br /><searchLink fieldCode="AU" term="%22Soto+Martin+M%22">Soto Martin M</searchLink>; CERPOP, Inserm, Toulouse, France.; University of Toulouse III, UPS, Toulouse, France.; Department of Geriatric Medicine, Toulouse University Hospital, Toulouse, France.<br /><searchLink fieldCode="AU" term="%22De+Mauleon+A%22">De Mauleon A</searchLink>; CERPOP, Inserm, Toulouse, France.; University of Toulouse III, UPS, Toulouse, France.; Department of Geriatric Medicine, Toulouse University Hospital, Toulouse, France.
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  Data: <i>Publisher: </i><searchLink fieldCode="PB" term="%22John+Wiley%22">John Wiley </searchLink><i>Country of Publication: </i>England <i>NLM ID: </i>8710629 <i>Publication Model: </i>Print <i>Cited Medium: </i>Internet <i>ISSN: </i>1099-1166 (Electronic) <i>Linking ISSN: </i><searchLink fieldCode="IS" term="%2208856230%22">08856230 </searchLink><i>NLM ISO Abbreviation: </i>Int J Geriatr Psychiatry <i>Subsets: </i>MEDLINE
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  Data: <searchLink fieldCode="MM" term="%22Alzheimer+Disease%22">Alzheimer Disease*</searchLink>/<searchLink fieldCode="MM" term="%22Alzheimer+Disease+economics%22">economics</searchLink> <br /><searchLink fieldCode="MM" term="%22Alzheimer+Disease%22">Alzheimer Disease*</searchLink>/<searchLink fieldCode="MM" term="%22Alzheimer+Disease+psychology%22">psychology</searchLink> <br /><searchLink fieldCode="MM" term="%22Psychomotor+Agitation%22">Psychomotor Agitation*</searchLink>/<searchLink fieldCode="MM" term="%22Psychomotor+Agitation+economics%22">economics</searchLink> <br /><searchLink fieldCode="MM" term="%22Aggression%22">Aggression*</searchLink>/<searchLink fieldCode="MM" term="%22Aggression+psychology%22">psychology</searchLink> <br /><searchLink fieldCode="MM" term="%22Health+Care+Costs%22">Health Care Costs*</searchLink>/<searchLink fieldCode="MM" term="%22Health+Care+Costs+statistics+%26+numerical+data%22">statistics & numerical data</searchLink> <br /><searchLink fieldCode="MM" term="%22Patient+Care%22">Patient Care*</searchLink>/<searchLink fieldCode="MM" term="%22Patient+Care+economics%22">economics</searchLink> <br /><searchLink fieldCode="MM" term="%22Cost+of+Illness%22">Cost of Illness*</searchLink><br /><searchLink fieldCode="MH" term="%22Caregivers%22">Caregivers</searchLink>/<searchLink fieldCode="MH" term="%22Caregivers+economics%22">economics</searchLink> ; <searchLink fieldCode="MH" term="%22Long-Term+Care%22">Long-Term Care</searchLink>/<searchLink fieldCode="MH" term="%22Long-Term+Care+economics%22">economics</searchLink> ; <searchLink fieldCode="MH" term="%22Humans%22">Humans</searchLink> ; <searchLink fieldCode="MH" term="%22Female%22">Female</searchLink> ; <searchLink fieldCode="MH" term="%22Male%22">Male</searchLink> ; <searchLink fieldCode="MH" term="%22Aged%22">Aged</searchLink> ; <searchLink fieldCode="MH" term="%22France%22">France</searchLink> ; <searchLink fieldCode="MH" term="%22Longitudinal+Studies%22">Longitudinal Studies</searchLink> ; <searchLink fieldCode="MH" term="%22Prospective+Studies%22">Prospective Studies</searchLink> ; <searchLink fieldCode="MH" term="%22Aged%2C+80+and+over%22">Aged, 80 and over</searchLink> ; <searchLink fieldCode="MH" term="%22Middle+Aged%22">Middle Aged</searchLink> ; <searchLink fieldCode="MH" term="%22Socioeconomic+Disparities+in+Health%22">Socioeconomic Disparities in Health</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: To date, no longitudinal study has assessed the effect of agitation on societal costs-particularly informal care costs-over time in Alzheimer's Disease (AD) patients with Agitation and Aggression (A/A) symptoms.<br />Objectives: This study estimates the impact of A/A symptoms evolution on longitudinal care costs including informal care costs in moderate-to-severe AD, considering patient and caregiver socioeconomic characteristics.<br />Design: A longitudinal trajectory clustering method was used on this longitudinal, prospective, multicenter observational cohort study.<br />Setting and Participants: 262 community-dwelling and long-term care facility (LTCF) patients of both sexes, aged 60 years and older, with clinically significant A/A symptoms were recruited from memory centers in southwest France.<br />Methods: Patients were followed for 12 months. A/A data was recorded by clinicians using the Neuropsychiatric Inventory (NPI-c). Costs were estimated from a societal perspective, including healthcare and informal care, using the RUD questionnaire. K-means longitudinal method identified A/A evolution profiles. Cost differences across A/A evolution profiles were analyzed using Generalized Linear Models.<br />Results: Two A/A evolution profiles were identified: mild symptoms at baseline with improvement (A) and moderate symptoms at baseline with limited improvement or stability (B). Annual costs were €22,959 in group A and €23,625 in group B excluding supervision, and €52,111 and €56,149, respectively, including supervision. In LTCF residents, higher A/A severity was associated with increased medical visits and medication costs, though overall cost differences were smaller. Informal care neared 70% of total costs for community-dwelling patients, with supervision covering the majority of these costs.<br />Conclusions: Evolution of A/A symptoms significantly increases both healthcare and informal care costs, particularly in at-home settings. Integrating systematic monitoring of behavioral symptoms into routine care would enable personalized, cost-effective strategies. Informal care costs, often undervalued and overlooked in economic analyzes, underscores the need for improvement in resource allocation and quality of life, for both patients and caregivers.<br />Clinical Trial Number: NCT03554226.<br /> (© 2026 The Author(s). International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.)
– Name: Ref
  Label: References
  Group: RefInfo
  Data: Rev Epidemiol Sante Publique. 2017 Oct;65 Suppl 4:S149-S167. (PMID: <searchLink fieldCode="PM" term="%2228756037%22">28756037)</searchLink><br />J Alzheimers Dis. 2021;83(1):89-101. (PMID: <searchLink fieldCode="PM" term="%2234250934%22">34250934)</searchLink><br />Struct Equ Modeling. 2014;21(2):263-279. (PMID: <searchLink fieldCode="PM" term="%2224729675%22">24729675)</searchLink><br />Geriatr Nurs. 2010 Jul-Aug;31(4):246-53. (PMID: <searchLink fieldCode="PM" term="%2220682402%22">20682402)</searchLink><br />J Am Med Dir Assoc. 2018 Jan;19(1):95.e1-95.e10. (PMID: <searchLink fieldCode="PM" term="%2229275939%22">29275939)</searchLink><br />J Am Geriatr Soc. 2006 May;54(5):796-803. (PMID: <searchLink fieldCode="PM" term="%2216696746%22">16696746)</searchLink><br />Neurodegener Dis. 2017;17(4-5):127-134. (PMID: <searchLink fieldCode="PM" term="%2228245482%22">28245482)</searchLink><br />Med Care. 2016 Feb;54(2):188-94. (PMID: <searchLink fieldCode="PM" term="%2226683778%22">26683778)</searchLink><br />Neuropsychiatr Dis Treat. 2019 Jul 17;15:2027-2034. (PMID: <searchLink fieldCode="PM" term="%2231413574%22">31413574)</searchLink><br />Int J Epidemiol. 2017 Apr 1;46(2):392-392d. (PMID: <searchLink fieldCode="PM" term="%2228168290%22">28168290)</searchLink><br />Alzheimers Dement (N Y). 2019 Nov 23;5:851-861. (PMID: <searchLink fieldCode="PM" term="%2231799369%22">31799369)</searchLink><br />Int Psychogeriatr. 2010 Sep;22(6):984-94. (PMID: <searchLink fieldCode="PM" term="%2220594384%22">20594384)</searchLink><br />Health Policy. 2014 May;116(1):114-22. (PMID: <searchLink fieldCode="PM" term="%2224461717%22">24461717)</searchLink><br />BMJ Open. 2015 Mar 13;5(3):e007382. (PMID: <searchLink fieldCode="PM" term="%2225770235%22">25770235)</searchLink><br />Comput Methods Programs Biomed. 2011 Dec;104(3):e112-21. (PMID: <searchLink fieldCode="PM" term="%2221708413%22">21708413)</searchLink><br />Eur J Health Econ. 2024 Apr;25(3):497-511. (PMID: <searchLink fieldCode="PM" term="%2237296350%22">37296350)</searchLink><br />Stat Med. 2004 Apr 30;23(8):1311-31. (PMID: <searchLink fieldCode="PM" term="%2215083485%22">15083485)</searchLink><br />Int Psychogeriatr. 2015 Jan;27(1):7-17. (PMID: <searchLink fieldCode="PM" term="%2225311499%22">25311499)</searchLink><br />J Prev Alzheimers Dis. 2021;8(2):199-209. (PMID: <searchLink fieldCode="PM" term="%2233569568%22">33569568)</searchLink><br />Eur J Ageing. 2016;13:271-279. (PMID: <searchLink fieldCode="PM" term="%2227610055%22">27610055)</searchLink><br />J Alzheimers Dis. 2022;89(1):359-366. (PMID: <searchLink fieldCode="PM" term="%2235871348%22">35871348)</searchLink><br />Biomed Res Int. 2013;2013:852368. (PMID: <searchLink fieldCode="PM" term="%2223509789%22">23509789)</searchLink><br />Alzheimers Dement. 2021 Oct;17(10):1687-1697. (PMID: <searchLink fieldCode="PM" term="%2234132461%22">34132461)</searchLink><br />Eur J Health Econ. 2004 Feb;5(1):36-45. (PMID: <searchLink fieldCode="PM" term="%2215452763%22">15452763)</searchLink><br />J Biomed Inform. 2023 Aug;144:104440. (PMID: <searchLink fieldCode="PM" term="%2237429511%22">37429511)</searchLink><br />Pharmacoeconomics. 2021 Nov;39(11):1209-1223. (PMID: <searchLink fieldCode="PM" term="%2234324174%22">34324174)</searchLink><br />JAMA Psychiatry. 2018 Jul 1;75(7):723-732. (PMID: <searchLink fieldCode="PM" term="%2229799983%22">29799983)</searchLink><br />Int Psychogeriatr. 2017 Oct;29(10):1723-1733. (PMID: <searchLink fieldCode="PM" term="%2228625207%22">28625207)</searchLink>
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  Data: <i>Keywords: </i>agitation/aggression; dementia; health care costs; informal care; longitudinal k‐means clustering; socioeconomic factors
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      – SubjectFull: Caregivers economics
        Type: general
      – SubjectFull: Long-Term Care economics
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      – SubjectFull: Humans
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      – SubjectFull: Psychomotor Agitation economics
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      – TitleFull: Longitudinal Impact of Agitation and Aggression Symptoms on Societal Costs in Alzheimer's Disease: A Focus on Informal Care and Socioeconomic Disparities.
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