Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27 Page 28 Page 29 Page 30 Page 31 Page 32 Page 33 Page 34 Page 35 Page 36 Page 37 Page 38 Page 39 Page 40 Page 41 Page 42 Page 43 Page 44 Page 45 Page 46 Page 47 Page 48 Page 49 Page 50 Page 51 Page 52 Page 53 Page 54 Page 55 Page 56 Page 57 Page 58 Page 59 Page 60 Page 61 Page 62 Page 63 Page 64 Page 65 Page 66 Page 67 Page 68 Page 69 Page 70 Page 71 Page 72 Page 73 Page 74 Page 75 Page 76 Page 77 Page 78 Page 79 Page 80 Page 81 Page 82 Page 83 Page 84 Page 85 Page 86 Page 87 Page 88 Page 89 Page 90 Page 91 Page 92 Page 93 Page 94 Page 95 Page 96 Page 97 Page 98 Page 99 Page 100 Page 101 Page 102 Page 103 Page 104 Page 105 Page 106 Page 107 Page 10845 CHAPTER 2 | THE AGING BR AIN Medical, Social, and Economic Impact Dementia has far-reaching impacts. For individ- uals with dementia, the medical consequences are numerous. One line of research using the HRS and ADAMS examines the impact of dementia on functional limitations. These lim- itations lead to a substantial need for caregiving, often provided by family members. The exten- sive information in the HRS on the amount and type of help provided to those with dementia offers insight into the extent of the social impact of dementia. Another line of research seeks to determine the monetary costs of dementia by estimating the dollar value of that caregiving, and the value of medical services used by those with dementia. Linkage to Medicare claims data enables researchers to include government pay- ments for dementia care in these estimates. Medical Consequences Research examines the differences in functional limitation across different dementia subtypes. Gure et al. (2010) show that AD, vascular demen- tia, and other dementia are all associated with a significant increase in the mean number of limitations to activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Examples of ADLs are walking, bathing and dressing. IADLs are things like shopping, preparing meals and managing money. Compared to AD, vascular and other types of dementia appear to cause more significant limitations in ADLs (Figure 2-7a). However, the limitations to IADLs are similar across all three subtypes (Figure 2-7b). This makes sense given the natural history of AD, where deterioration in ability to perform IADLs tends to precede ADL limitations. A related ADAMS study finds that certain neuropsychiatric symptoms, which are common in dementia and CIND, are associated with more functional impairment (Okura et al. 2010). For example, dementia patients with clinical depres- sion are much more likely than those without de- pression to have significant problems with ADLs. Importantly, depressive symptoms and cognitive decline appear to contribute additively to mortality (Mehta et al. 2003). Davydow et al. (2015) find that individuals with co-occurring depression and CIND represent a high-risk group that may benefit from targeted interventions to prevent stroke. A study of the medical consequences of de- mentia in the 1990s, which uses data from one of the earliest cohorts in the HRS, finds that demen- tia is a primary cause of nursing home admission, even after taking into account its impact on func- tional limitations (Banaszak-Holl et al. 2004). 0 0.5 1 1.5 2 2.5 3 3.5 4 Alzheimer's dementia Vascular dementia Dementia, other Nondemented FIGURE 2-7a Mean number of activity of daily living (ADL) limitations by dementia subtype: 2002 Source: Gure et al. (2010). 0 0.5 1 1.5 2 2.5 3 3.5 4 Alzheimer's dementia Vascular dementia Dementia, other Nondemented FIGURE 2-7b Mean number of instrumen- tal activity of daily living (IADL) limitations by dementia subtype: 2002 Source: Gure et al. (2010). Dementia is a primary cause of nursing home admission, even after taking into account its impact on functional limitations.