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      Time Trends in the Prevalence of Neurocognitive Disorders and Cognitive Impairment in the United States: The Effects of Disease Severity and Improved Ascertainment

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          Abstract

          BACKGROUND:

          Trends in the prevalence of cognitive impairment (CI) based on cognitive assessment instruments are often inconsistent with those of neurocognitive disorders (ND) based on Medicare claims records.

          OBJECTIVE:

          We hypothesized that improved ascertainment and resulting decrease in disease severity at the time of diagnosis are responsible for this phenomenon.

          METHODS:

          Using Medicare data linked to the Health and Retirement Study (1992–2012), we performed a joint analysis of trends in CI and ND to test our hypothesis.

          RESULTS:

          We identified two major contributors to the divergent directions in CI and ND trends: reductions in disease severity explained more than 60% of the differences between CI and ND prevalence over the study period; the remaining 40% was explained by a decrease in the fraction of undiagnosed individuals.

          DISCUSSION:

          Improvements in the diagnoses of ND diseases were a major contributor to reported trends in AD and CI. Recent forecasts of CI and ND trends in the U.S. may be overly pessimistic.

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          Author and article information

          Journal
          9814863
          21942
          J Alzheimers Dis
          J. Alzheimers Dis.
          Journal of Alzheimer's disease : JAD
          1387-2877
          1875-8908
          26 October 2018
          2018
          02 November 2018
          : 64
          : 1
          : 137-148
          Affiliations
          [1 ]Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC
          [2 ]Department of Surgery, Duke University Medical Center, Durham, NC
          Author notes
          Corresponding author: Igor Akushevich, Ph.D., Biodemography of Aging Research Unit, Center for Population Health and Aging, Social Science Research Institute, Duke University, 2024 W. Main Str., Durham, NC 27708, phone: (919)668-2715, igor.akushevich@ 123456duke.edu
          Article
          PMC6214183 PMC6214183 6214183 nihpa994417
          10.3233/JAD-180060
          6214183
          29865067
          1feaf6dd-b0d2-4b91-ab1d-5b57cb2062c3
          History
          Categories
          Article

          health and retirement study,disease prevalence,telephone interview for cognitive status,time trends,cognitive impairment,neurocognitive disorders,severity,underdiagnosis,Medicare,ascertainment

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