Identification of cognitively impaired patients at risk for development of Alzheimer's disease dementia: an analysis of US Medicare claims data.

Background: Identifying factors associated with transitioning from mild cognitive impairment (MCI) to dementia due to Alzheimer's disease (AD dementia) or dementia due to any cause (all-cause dementia) may inform economic assessments of disease and early care planning.

Research Design And Methods: A multivariate logistic regression approach identified potential predictors of progression to AD dementia or all-cause dementia in individuals with MCI or cognitive impairment (CI). Eligible patients and variables of interest were identified using claims data from the Medicare Advantage Patient Database, by Optum.

Results: Predictors of an AD dementia diagnosis included age (odds ratio [OR], 1.71) and use of antipsychotics (OR, 2.50) and hypertension medication (OR, 1.25). Medication use for comorbid conditions was a better indicator of risk than comorbidity coding. Diagnosis of CI by a neurologist increased the odds of an AD dementia diagnosis. Possible protective factors for progression included the use of anxiolytics (OR, 0.76), inpatient status at time of diagnosis (OR, 0.49), and a history of stroke (OR, 0.87). None of these factors differentiated AD dementia from all-cause dementia.

Conclusions: Identifying patients at risk for AD dementia allows for improved system-level planning to guide policy and optimize economic and clinical outcomes for patients, caregivers, and society.