Consequences of Anosognosia on the Cost of Caregivers' Care in Alzheimer's Disease

Background: Anosognosia is common in patients with Alzheimer's disease (AD) and it is frequently related to an increase in time of care demand. Objective: The aim of the study was to examine the effect of anosognosia on the total costs of informal care in patients with AD. Methods: This was a prospective longitudinal study with community-dwelling AD patients. Anosognosia, time of informal care, and the use of support services (e.g., day care centers) were recorded at baseline and after 24 months. The cost of informal caregiving was calculated as 'market price'. Results: At baseline, the prevalence of anosognosia was 54.3 (n=221), and 43.9 were classified as mild-AD. The average time of care was 5h/day±2.4 (IADL: 1.3h/day±1.4 and BADL: 3.6h/day±1.5). Thirty percent of the patients used home care services, and 25.1 attended a day care center. Patients with anosognosia received more time of care and were more likely to use support services than did their no-anosognosia peers, including institutionalization. The mean cost of support services was 490.4€ /month (SD=413.1€; range=25-2,212.38€), while the overall cost of care (support services plus informal care) was 1,787€ /month (SD=972.4€), ranging from 834.1€ in mild-AD without anosognosia patients, to 2,424.8€ in severe-AD with incident anosognosia patients. Conclusions: Anosognosia was associated with an increased number of hours of informal care, and a greater use of support services, regardless of the severity of the dementia, which lead to an increase of the total family-care costs.