Estimation and validation of a multiattribute model of Alzheimer disease progression.
Abstract
OBJECTIVES: To estimate and validate a multiattribute model of the clinical course
of Alzheimer disease (AD) from mild AD to death in a high-quality prospective cohort
study, and to estimate the impact of hypothetical modifications to AD progression
rates on costs associated with Medicare and Medicaid services. DATA AND METHODS: The
authors estimated sex-specific longitudinal Grade of Membership (GoM) models for AD
patients (103 men, 149 women) in the initial cohort of the Predictors Study (1989-2001)
based on 80 individual measures obtained every 6 mo for 10 y. These models were replicated
for AD patients (106 men, 148 women) in the 2nd Predictors Study cohort (1997-2007).
Model validation required that the disease-specific transition parameters be identical
for both Predictors Study cohorts. Medicare costs were estimated from the National
Long Term Care Survey. RESULTS: Sex-specific models were validated using the 2nd Predictors
Study cohort with the GoM transition parameters constrained to the values estimated
for the 1st Predictors Study cohort; 57 to 61 of the 80 individual measures contributed
significantly to the GoM models. Simulated, cost-free interventions in the rate of
progression of AD indicated that large potential cost offsets could occur for patients
at the earliest stages of AD. CONCLUSIONS: AD progression is characterized by a small
number of parameters governing changes in large numbers of correlated indicators of
AD severity. The analysis confirmed that the progression of AD represents a complex
multidimensional physiological process that is similar across different study cohorts.
The estimates suggested that there could be large cost offsets to Medicare and Medicaid
from the slowing of AD progression among patients with mild AD. The methodology appears
generally applicable in AD modeling.
Type
Journal articleSubject
AgedAlzheimer Disease
Bayes Theorem
Biomarkers
Decision Making
Decision Support Techniques
Disease Progression
Female
Health Status Indicators
Humans
Likelihood Functions
Longitudinal Studies
Male
Markov Chains
Medicaid
Medicare
Models, Economic
Models, Statistical
Proportional Hazards Models
Psychometrics
Sex Factors
United States
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https://hdl.handle.net/10161/14916Published Version (Please cite this version)
10.1177/0272989X10363479Publication Info
Stallard, Eric; Kinosian, Bruce; Zbrozek, Arthur S; Yashin, Anatoliy I; Glick, Henry
A; & Stern, Yaakov (2010). Estimation and validation of a multiattribute model of Alzheimer disease progression.
Med Decis Making, 30(6). pp. 625-638. 10.1177/0272989X10363479. Retrieved from https://hdl.handle.net/10161/14916.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Anatoli I. Yashin
Research Professor in the Social Science Research Institute

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