Estimation and validation of a multiattribute model of Alzheimer disease progression.
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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.
Decision Support Techniques
Health Status Indicators
Proportional Hazards Models
Published Version (Please cite this version)10.1177/0272989X10363479
Publication InfoGlick, HA; Kinosian, B; Stallard, Eric; Stern, Y; Yashin, Anatoli I; & Zbrozek, AS (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 http://hdl.handle.net/10161/14916.
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Research Professor in the SocialScience Research Institute
I am a Research Professor in the Social Science Research Institute and Co-Director of the Biodemography of Aging Research Unit at Duke University. I am a Member of the American Academy of Actuaries, a Fellow of the Conference of Consulting Actuaries, and an Associate of the Society of Actuaries. My research expertise includes modeling and forecasting for biomedical demography and health/LTC actuarial practice. My expertise in these areas is evidenced by my five books, five monographs, 151 sci
Research Professor in the Social Science Research Institute
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