b"CHAPTER 2 | THE AGING BRAINMedical, Social, and with dementia. Linkage to Medicare claims dataFIGURE 2-7bMean number of instrumen-Economic Impact enables researchers to include government pay- tal activity of daily living (IADL) limitations Dementia has far-reaching impacts. For individ- ments for dementia care in these estimates. by dementia subtype: 2002uals with dementia, the medical consequencesSource: Gure et al. (2010).are numerous. One line of research using theMedical ConsequencesHRS and ADAMS examines the impact ofResearch examines the differences in functional4dementia on functional limitations. These lim- limitation across different dementia subtypes. 3.5itations lead to a substantial need for caregiving,Gure et al. (2010) show that AD, vascular demen-often provided by family members. The exten- tia, and other dementia are all associated with3sive information in the HRS on the amount anda significant increase in the mean number of2.5type of help provided to those with dementialimitations to activities of daily living (ADLs) and offers insight into the extent of the social impactinstrumental activities of daily living (IADLs).2of dementia. Another line of research seeks toExamples of ADLs are walking, bathing and1.5determine the monetary costs of dementia bydressing.1estimating the dollar value of that caregiving,IADLs are things like shopping, preparing and the value of medical services used by thosemeals and managing money. Compared to AD,0.5vascular and other types of dementia appear0to cause more significant limitations in ADLsAlzheimer's dementia Dementia, otherFIGURE 2-7aMean number of activity of(Figure 2-7a). However, the limitations to IADLsVascular dementia Nondementeddaily living (ADL) limitations by dementiaare similar across all three subtypes (Figure 2-7b). subtype: 2002 This makes sense given the natural history of AD, Source: Gure et al. (2010). where deterioration in ability to perform IADLsA study of the medical consequences of de-tends to precede ADL limitations.mentia in the 1990s, which uses data from one of A related ADAMS study finds that certainthe earliest cohorts in the HRS, finds that demen-4neuropsychiatric symptoms, which are commontia is a primary cause of nursing home admission, 3.5 in dementia and CIND, are associated with moreeven after taking into account its impact on func-3 functional impairment (Okura et al. 2010). Fortional limitations (Banaszak-Holl et al. 2004). example, dementia patients with clinical depres-2.5 sion are much more likely than those without de-2 pression to have significant problems with ADLs.Dementia is a primary cause of 1.5 Importantly, depressive symptoms andnursing home admission, even cognitive decline appear to contribute additively 1 to mortality (Mehta et al. 2003). Davydow et al.after taking into account its impact 0.5 (2015) find that individuals with co-occurringon functional limitations.depression and CIND represent a high-risk group 0 that may benefit from targeted interventions to Alzheimer's dementia Dementia, other prevent stroke.Vascular dementia Nondemented45"