Agitation Linked to Increased Clinical, Economic Burden Among Patients With Alzheimer Dementia

In an observational study, patients with Alzheimer dementia (AD) with associated agitation had shorter time to mortality and increased comorbidities, medication use, and health care costs compared with patients with AD but no agitation.

In May 2023, the FDA approved the first drug to treat agitation symptoms associated with dementia due to AD, but the clinical burden associated with agitation due to AD remains, according to the study authors.

“Given the prior lack of effective pharmacological treatments and the negative impact of symptoms on daily life, agitation is associated with a substantial clinical burden,” the authors explained.

To illustrate this point, researchers compared the clinical characteristics, health care costs, and mortality among patients aged 55 years or older with AD with and without agitation using data from the Reliant Medical Group database from January 2016 through March 2020.

>> Research Summary: Heart Rate Variability Associated With Increased Risk of Agitation Among Patients With Alzheimer Disease

The study participants (n = 711) were observed during a randomly selected 12-month study period after AD diagnosis, and using information recorded in medical charts, researchers classified them in either the agitation cohort (n = 240) or the no agitation cohort (n = 471).

The results showed that the most common agitation behaviors among the agitation cohort were hitting (20.8%), pacing/aimless wandering (17.5%), and cursing/verbal aggression (15%). Further, infection, depression, and altered mental status were more frequently observed in the agitation cohort than the no agitation group. Similarly, the use of antidepressants, anticonvulsants, antipsychotics, and antianxiety medications was more common in the agitation vs no agitation cohort.

Additionally, generally due to higher inpatient expenses, the total all-cause health care costs were $4287 higher per-patient-per-year in the agitation cohort vs no agitation cohort (P = 0.04). Death was more common and time to death and institutionalization was shorter in the agitation vs no agitation cohort as well.

This study had limitations. For example, the study only included participants with commercial insurance from an integrated delivery network in Massachusetts. Additionally, most of the participants were White. Therefore, the results may not be generalizable to the US population with AD.

“Among patients with AD in this study, agitation was associated with increased comorbidities, medication use, and health care costs, highlighting the additional burden that agitation poses for the management of AD,” the authors concluded. “Strategies focusing on improving agitation management have the potential to mitigate the burden associated with AD for payers and the health care system.”

— Anthony Calabro, MA

Reference:
Grossberg G, Urganus A, Schein J, et al. A real-world assessment of healthcare costs associated with agitation in Alzheimer's dementia. J Med Econ. 2024;27(1):99-108. doi:10.1080/13696998.2023.2291966