Patients with Alzheimer’s disease experience related comorbidities prior to diagnosis

Even before an official diagnosis of Alzheimer’s disease, patients had significantly higher — and increasing — rates of comorbidities linked to the disease, according to a recent presentation at the Alzheimer’s Association International Conference.

“As cognitive impairment may develop years before a formal [Alzheimer’s disease] diagnosis, management of comorbidities may become more challenging even prior to diagnosis,” Urvi Desai, of the Analysis Group Inc. in Boston, and colleagues wrote.“These findings highlight the growing burden in the prediagnosis period and emphasize the need for timely recognition and management of [Alzheimer’s disease] patients.”

Researchers randomly sampled 5% of Medicare claims data, dividing it into two cohorts. The first consisted of patients who had two or more claims indicating Alzheimer’s disease by the ICD-9 code, including the patient’s first-ever claim for Alzheimer’s disease from 2012 to 2014. The second cohort was the control group, matched at a 1:1 ratio, and contained patients with two or more medical claims over the same period who had no dementia and no indication of cognitive impairment before their index date.

Desai and colleagues examined the claims for rates of all-cause ED visits, all-cause hospitalizations, potentially avoidable hospitalizations, and falls in 3 years before a patient received a diagnosis of Alzheimer’s disease. The mean age of the participants was 83 years, and they had a baseline mean Charlson comorbidity index of 1.6.

Researchers found that after matching 19,679 pairs of patients each year before index, those with Alzheimer’s disease were more likely to have all-cause ED visits (P < 0.05), all-cause hospitalizations (P < 0.05), one or more potentially avoidable hospitalizations, (P < 0.05) and falls relative to matched controls (P < 0.05). In addition, the potential for all outcomes went up over time, and similar increasing trends in RR were also observed in all of the comorbidities except the potentially avoidable hospitalizations. – by Janel Miller

Reference:

Desai U, et al. Trends in health service use and potentially avoidable hospitalizations prior to Alzheimer’s disease diagnosis: a matched, retrospective study of U.S. Medicare beneficiaries. Presented at: Alzheimer's Association International Conference; July 16-20, 2017; London.

Disclosure: Healio Family Medicine was unable to determine researchers’ relevant disclosures prior to publication.