Predictors and consequences of the timing and accuracy of clinical dementia diagnosis

项目总结/摘要 这个项目的首要目标是围绕预测因素和后果建立证据基础 阿尔茨海默病和相关痴呆（ADRD）的临床诊断不足与早期临床诊断的 医疗保健设置。许多符合痴呆症诊断标准的老年人， 超过一半的人在医疗保健环境中诊断不足，这意味着他们是由他们的提供者多年来诊断出来的。 在符合痴呆症标准的症状首次出现（即晚期诊断）或从未被诊断（即 漏诊）。我们对驱动临床接收时间的因素知之甚少。 痴呆症的诊断这一领域的进展将使我们能够解决诊断差异。近年来， 还推动了痴呆症的早期临床诊断（即，识别患有痴呆症的人， 至症状发作时），尽管缺乏有效的ADRD疾病改变治疗。的 早期临床痴呆症诊断的重要性将得到明确证据的支持，这将导致更好的 诊断患者的长期健康，更适当的医疗保健利用，或降低医疗成本。 相反，危害的证据表明，有必要重新关注改善痴呆症护理。 然而，与临床痴呆症诊断的时间相关的益处和危害仍然很差 表征了该项目将利用来自5个国家的独特数据， 来自拉什阿尔茨海默病中心（RADC）的多样化，协调的老龄化队列，具有强大的认知能力， 从1991年到现在的评估和链接的医疗保险索赔记录。这些数据非常适合这些 目的，因为基于研究的痴呆症确定是频繁的（每年），而痴呆症的分类不是 因此，它独立于在医疗保健环境中捕获的临床诊断， 医疗保险索赔。我们建议描述使老年人或多或少患有痴呆症的因素 可能在首次符合ADRD标准（目标1）时接受临床诊断， 早期诊断的人是否有更好的健康结果（目标2），以及更适当的医疗保健 利用率和减少相关费用（目标3）。这些努力是及时的，并有可能改变公众 认知、临床实践和卫生政策。患者和医疗提供者将能够更好地 知情选择何时寻求或提供认知评估，而公共卫生机构，健康 系统和健康保险公司将能够利用我们的研究结果来决定是否以及如何促进早期 痴呆症的认知评估和诊断。

Project Summary / Abstract The overarching goal of this project is to develop the evidence base around the predictors and consequences of clinical underdiagnosis vs early clinical diagnosis of Alzheimer’s disease and related dementias (ADRD) in healthcare settings. Many older persons who would meet diagnostic criteria for dementia—potentially more than half—are underdiagnosed in the healthcare setting, meaning they are diagnosed by their provider years after symptoms that meet criteria for dementia first emerge (i.e. late diagnosis) or are never diagnosed (i.e. missed diagnosis). We know relatively little about the factors that drive the timing of receipt of a clinical diagnosis of dementia. Advances in this area would allow us to address diagnostic disparities. In recent years, there has also been a push for early clinical diagnosis of dementia (i.e. identifying persons with dementia close to the time of symptom onset), despite lack of an effective disease-altering treatment for ADRD. The importance of an early clinical dementia diagnosis would be bolstered by clear evidence that it led to better long-term health for diagnosed patients, more appropriate healthcare utilization, or decreased medical costs. Conversely, evidence of harms would suggest a renewed focus on improving dementia care is warranted. However, the benefits and harms related to the timing of a clinical dementia diagnosis remain poorly characterized. This project will address these crucial gaps in understanding by leveraging unique data from 5 diverse, harmonized cohorts of aging from the Rush Alzheimer’s Disease Center (RADC) with robust cognitive assessment and linked Medicare claims records from 1991 to the present. This data is perfectly suited to these aims, as study-based dementia ascertainment is frequent (annual) and classification of dementia is not disclosed to participants—thus it is independent of clinical diagnosis in healthcare settings captured in the Medicare claims. We propose to characterize the factors that make older adults with dementia more or less likely to receive a clinical diagnosis around the time when they first meet criteria for ADRD (Aim 1), and to test whether those with early diagnosis have better health outcomes (Aim 2), and more appropriate healthcare utilization and less associated costs (Aim 3). These efforts are timely and have the potential to change public perception, clinical practice, and health policy. Patients and medical providers will be able to make better informed choices about when to seek or offer cognitive evaluation, while public health agencies, health systems, and health insurers will be able to use our findings to decide whether and how to promote early cognitive evaluation and diagnosis of dementia.