University of Oulu

Janssen, N., Handels, R. L., Wimo, A., Antikainen, R., Laatikainen, T., Soininen, H., Strandberg, T., Tuomilehto, J., Kivipelto, M., Evers, S. M. A. A., Verhey, F. R. J., & Ngandu, T. (2022). Association between cognition, health related quality of life, and costs in a population at risk for cognitive decline. Journal of Alzheimer’s Disease, 89(2), 623–632.

Association between cognition, health related quality of life, and costs in a population at risk for cognitive decline

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Author: Janssen, Niels1; Handels, Ron L.1,2; Wimo, Anders2,3;
Organizations: 1Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
2Department of Neurobiology, Care Science and Society, Division of Neurogeriatrics, Karolinska Institute, Stockholm, Sweden
3Centre for Research & Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden
4Center for Life Course Health Research/Geriatrics, University of Oulu, Oulu, Finland
5Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
6Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
7Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland
8Joint Municipal Authority for North Karelia Social and Health Services (Siun sote), Finland
9Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland
10Department of Neurology, Kuopio University Hospital, Kuopio, Finland
11Institute of Health Sciences/Geriatrics, University of Oulu and Oulu University Hospital, Oulu, Finland
12Department of Medicine, Geriatric Clinic, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland
13Department of Public Health, University of Helsinki, Helsinki, Finland
14South Ostrobothnia Central Hospital, Seinajoki, Finland
15Saudi Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
16Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
17Neuroepidemiology and Ageing Research Unit, School of Public Health, Imperial College London, London, UK
18Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
19Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Centre for Economic Evaluation Utrecht, Utrecht, The Netherlands
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.1 MB)
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Language: English
Published: IOS Press, 2022
Publish Date: 2022-12-13


Background: The association between health-related quality of life (HRQoL) and care costs in people at risk for cognitive decline is not well understood. Studying this association could reveal the potential benefits of increasing HRQoL and reducing care costs by improving cognition.

Objective: In this exploratory data analysis we investigated the association between cognition, HRQoL utilities and costs in a well-functioning population at risk for cognitive decline.

Methods: An exploratory data analysis was conducted using longitudinal 2-year data from the FINGER study (n = 1,120). A change score analysis was applied using HRQoL utilities and total medical care costs as outcome. HRQoL utilities were derived from the Short Form Health Survey-36 (SF-36). Total care costs comprised visits to a general practitioner, medical specialist, nurse, and days at hospital. Analyses were adjusted for activities of daily living (ADL) and depressive symptoms.

Results: Although univariable analysis showed an association between cognition and HRQoL utilities, multivariable analysis showed no association between cognition, HRQoL utilities and total care costs. A one-unit increase in ADL limitations was associated with a -0.006 (p < 0.001) decrease in HRQoL utilities and a one-unit increase in depressive symptoms was associated with a -0.004 (p < 0.001) decrease in HRQoL utilities.

Conclusions: The level of cognition in people at-risk for cognitive decline does not seem to be associated with HRQoL utilities. Future research should examine the level at which cognitive decline starts to affect HRQoL and care costs. Ideally, this would be done by means of cross-validation in populations with various stages of cognitive functioning and decline.

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Series: Journal of Alzheimer's disease
ISSN: 1387-2877
ISSN-E: 1875-8908
ISSN-L: 1387-2877
Volume: 89
Issue: 2
Pages: 623 - 632
DOI: 10.3233/JAD-215304
Type of Publication: A1 Journal article – refereed
Field of Science: 3142 Public health care science, environmental and occupational health
3124 Neurology and psychiatry
3121 General medicine, internal medicine and other clinical medicine
Funding: The authors wish to thank all participants and staff and members of FINGER study group. RH and NJ acknowledge financial support received from the Dutch Alzheimer’s Association, “Alzheimer Nederland,” grant number WE.15-2016-09. FINGER trial has received research support from the Academy of Finland (grant 317465), Finnish Social Insurance Institution, Finnish Ministry of Education and Culture, Juho Vainio Foundation (Finland), EU Joint Programme - Neurodegenerative Disease Research (MIND-AD and EURO-FINGERS), Finnish Cultural Foundation, Jalmari and Rauha Ahokas Foundation (Finland), Yrjö Jahnsson Foundation (Finland), State research funding (EVO/VTR grants) of Oulu University Hospital, Oulu City Hospital and Kuopio University Hospital (Finland), UEF Strategic funding for UEFBRAIN (Finland), Alzheimer’s Research and Prevention Foundation (US), Alzheimerfonden (Sweden), Swedish Research Council, Center for Innovative Medicine (CIMED) at Karolinska Institutet, Region Stockholm (ALF, NSV), Knut and Alice Wallenberg Foundation (Sweden), Stiftelsen Stockholms sjukhem (Sweden), Konung Gustaf V:s och Drottning Victorias Frimurarstiftelse (Sweden).
Academy of Finland Grant Number: 317465
Detailed Information: 317465 (Academy of Finland Funding decision)
Copyright information: © 2022 The authors. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (CC BY-NC 4.0).