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Expected and diagnosed rates of mild cognitive impairment and dementia in the U.S. Medicare population: observational analysis
Open accessAbstract
Background: With the emergence of disease-modifying Alzheimer’s treatments, timely detection of early-stage disease is more important than ever, as the treatment will not be indicated for later stages. Contemporary population-level data for detection rates of mild cognitive impairment (MCI), the stage at which treatment would ideally start, are lacking, and detection rates for dementia are only available for subsets of the Medicare population. We sought to compare documented diagnosis rates of MCI and dementia in the full Medicare population with expected rates based on a predictive model. Methods: We performed an observational analysis of Medicare beneficiaries aged 65 and older with a near-continuous enrollment over a 3-year observation window or until death using 100% of the Medicare fee-for-service or Medicare Advantage Plans beneficiaries from 2015 to 2019. Actual diagnoses for MCI and dementia were derived from ICD-10 codes documented in those data. We used the 2000–2016 data of the Health and Retirement Study to develop a prediction model for expected diagnoses for the included population. The ratios between actually diagnosed cases of MCI and dementia over number of cases expected, the observed over expected ratio, reflects the detection rate. Results: Although detection rates for MCI cases increased from 2015 to 2019 (0.062 to 0.079), the results mean that 7.4 of 8 million (92%) expected MCI cases remained undiagnosed. The detection rate for MCI was 0.039 and 0.048 in Black and Hispanic beneficiaries, respectively, compared with 0.098 in non-Hispanic White beneficiaries. Individuals dually eligible for Medicare and Medicaid had lower estimated detection rates than their Medicare-only counterparts for MCI (0.056 vs 0.085). Dementia was diagnosed more frequently than expected (1.086 to 1.104) from 2015 to 2019, mostly in non-Hispanic White beneficiaries (1.367) compared with 0.696 in Black beneficiaries and 0.758 in Hispanic beneficiaries. Conclusions: These results highlight the need to increase the overall detection rates of MCI and of dementia particularly in socioeconomically disadvantaged groups.
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“suggesting there may be as many as 8 million people with undiagnosed MCI”
From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [696]
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“A recent study of Medicare beneficiaries found that only about 8% of expected mild cognitive impairment (MCI) cases are diagnosed on average, suggesting there may be as many as 8 million people with undiagnosed MCI”
From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [696]
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“In other words, there may be around 10 million Americans with undiagnosed MCI, and around half of them would have the AD pathology [24].”
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“In fact, approximately 7.4 million of 8 million Medicare beneficiaries may have undiagnosed MCI (33).”
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Should cognition be the fifth vital sign in nursing?
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“While the real number of cases is unknown, AF could be asymptomatic [5] and cognitive dysfunction (CD) is diagnosed in several cases too late [6].”
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“Up to 92% of patients with mild cognitive impairments are undiagnosed and, therefore, untreated (Mattke et al., 2023).”
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Metadata
- Authors
- Mattke, S., Jun, H., Chen, E., Liu, Y., Becker, A., & Wallick, C.
- Affiliations
- University of Southern California (US)
- Harvard University (US)
- Roche (United States) (US)
- Corresponding author
- Mattke, Soeren
- Venue
- Alzheimer's Research & Therapy
- Published
- 2023-07-22
- Volume
- 15
- Issue
- 1
- Pages
- 128-128
- ISSN
- 1758-9193 (ISSN-L)
- PMC
- PMC10362635
- OpenAlex
- W4385075320
- Cited by
- 106
- References
- 38
- Citations by year
- 2026: 32 · 2025: 39 · 2024: 32 · 2023: 3
- FWCI
- 21.59
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Alzheimer s Research & Therapy (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Genentech, Inc., a member of the Roche Group
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Oncology › Cancer-related cognitive impairment studies
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Alzheimer's disease research and treatments
- Keywords
- mild cognitive impairment, dementia, detection rate, underdiagnosis, Medicare beneficiaries, older adults, racial and ethnic disparities, prediction model, ICD-10 diagnoses
- MeSH terms
- Aged, Alzheimer Disease, Medicare, Humans, United States, Cognitive Dysfunction
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