Prevalence of Memory-Related Diagnoses Among U.S. Older Adults With Early Symptoms of Cognitive Impairment
Open accessAbstract
Background: Early diagnosis of cognitive impairment may confer important advantages. Yet the prevalence of memory-related diagnoses among older adults with early symptoms of cognitive impairment is unknown. Methods: A retrospective, longitudinal cohort design using 2000–2014 Health and Retirement Survey–Medicare linked data. We leveraged within-individual variation to examine the relationship between incident cognitive impairment and receipt of diagnosis among 1225 individuals aged 66 or older. Receipt of a memory-related diagnosis was determined by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Incident cognitive impairment was defined as the first assessment wherein the participant’s modified Telephone Interview for Cognitive Status score was less than 12. Results: The unadjusted prevalence of memory-related diagnosis at cognitive impairment was 12.0%. Incident cognitive impairment was associated with a 7.3% (95% confidence interval [CI], 5.6% to 9.0%; p < .001) higher adjusted probability of any memory-related diagnosis overall, yielding 9.8% adjusted prevalence of diagnosis. The increase in likelihood of diagnosis associated with cognitive decline was significantly higher among non-Hispanic Whites than non-Hispanic Blacks (8.2% vs −0.7%), and among those with at least a college degree than those with a high school diploma or less (17.4% vs 6.8% vs 1.6%). Those who were younger, had below-median wealth, or without a partner had lower probability of diagnosis than their counterparts. Conclusions: We found overall low prevalence of early diagnosis, or high rate of underdiagnosis, among older adults showing symptoms of cognitive impairment, especially among non-Whites and socioeconomically disadvantaged subgroups. Our findings call for targeted interventions to improve the rate of early diagnosis, especially among vulnerable populations.
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Underdiagnosis is higher in Black and Hispanic older adults.
“Some studies indicate that underdiagnosis is higher in Black and Hispanic older adults.”
From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [268]
The Results (page unavailable) show a significantly smaller increase in diagnosis likelihood for non-Hispanic Black than for non-Hispanic White older adults with early cognitive-impairment symptoms. The Discussion (page unavailable) reports substantially lower diagnosis prevalence for non-Whites overall, but does not establish a higher underdiagnosis rate for Hispanic older adults specifically. (LLM, conf=0.84)
Experimental — accuracy not yet measuredUnderdiagnosis is most pronounced at the earliest stages of dementia when symptoms are mild.
“Underdiagnosis is most pronounced at the earliest stages of dementia when symptoms are mild.”
From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [268]
The Discussion reports an 88.0%–90.2% underdiagnosis rate among older adults with early symptoms of cognitive impairment and says dementia is more likely to be detected than impairment at an earlier stage. This supports greater underdiagnosis when impairment is early, but the study does not establish that underdiagnosis is most pronounced specifically at the earliest stages of dementia; its early-symptom group includes cognitive impairment without dementia. (LLM, conf=0.85)
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- Authors
- Qian, Y., Chen, X., Tang, D., Kelley, A. S., & Li, J.
- Affiliations
- Weill Cornell Medicine (US)
- Yale University (US)
- Shanghai Medical College of Fudan University (CN)
- James J. Peters VA Medical Center (US)
- Corresponding author
- Li, Jing
- Venue
- The Journals of Gerontology: Series A
- Publisher
- Oxford University Press (OUP)
- Published
- 2021-02-12
- Volume
- 76
- Issue
- 10
- Pages
- 1846-1853
- ISSN
- 1079-5006 (ISSN-L)
- 1758-535X
- PMC
- PMC8436977
- OpenAlex
- W3127175336
- Cited by
- 23
- References
- 33
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 8 · 2023: 6 · 2022: 1
- FWCI
- 2.69
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- The Journals of Gerontology Series A (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Weill Cornell Medicine (K01AG066946)
- National Institutes of Health (P30AG021342, K01AG053408, K24 AG062785, R01 AG054540)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cancer-related cognitive impairment studies
- Social Sciences › Psychology › Applied Psychology › Psychological Testing and Assessment
- Keywords
- cognitive impairment, underdiagnosis, early diagnosis, older adults, prevalence, racial disparities, socioeconomic disparities, educational attainment, marital status, wealth, cognitive decline, Medicare beneficiaries
- MeSH terms
- Aged, Medicare, Humans, Retrospective Studies, United States, Cohort Studies, Prevalence, Cognitive Dysfunction
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