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 difficult at the onset of symptoms, when the memory decline or a behavioral changes are easily explained with stress or general age-related asthenia, slowing down the correct diagnosis and often requires very expensive diagnostical examinations. The aim of this work was at evaluating the global price sustained by each patient before reaching the diagnosis of probable AD, paid for examination, drugs and specialists consultations because of the progressive cognitive and/or behavioral diseases. Twenty patients were interviewed by a semi-structured method, in order to evaluate the clinical onset of the disease, the number of specialists consulted before diagnosis of probable AD, the list of examinations performed, the costs of examinations and drugs administered in this period. The mean delay between clinical onset and diagnosis of probable AD was 30.7 +/- 32.7 months (SD). The clinical picture at onset was dominated by behavioral disease in 66 % of cases and by cognitive symptoms in 34 % of cases. The patients consulted on average 2 specialists before diagnosis. Five patients were affected also by other concomitant pathologies at the onset of cognitive decline and, for this reason, these patients were visited and treated also by other specialists who made hypothesis or reaffirm the diagnostical course for a cognitive decline. The examinations performed, suggested by the specialist, were: blood chemistry, computed tomography (CT) scans, ultrasonography of cervical arteries, magnetic resonance imagin electroencephalography. single photon positron emission tomography. The mean cost sustained by each patient for examinations performed by the public health service was about 112 US Dollars, while the mean cost sustained by each patient for examinations performed by private health service was about 402 Dollars. The specialists prescribed more often vitamins, nootropics and benzodiazepines. The most expensive drugs were the psychiatric drugs. The main price sustained for drugs was 505 +/- 233 Dollars. AD is a strongly devastating and expensive illness, and the magnitude of the economic burden imposed by the disease on society will increase in the 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 therapies and diagnostical examinations