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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.


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 ND and CI. Recent forecasts of CI and ND trends in the U.S. may be overly pessimistic.

SUBMITTER: Akushevich I 

PROVIDER: S-EPMC6214183 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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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.

Akushevich Igor I   Yashkin Arseniy P AP   Kravchenko Julia J   Ukraintseva Svetlana S   Stallard Eric E   Yashin Anatoliy I AI  

Journal of Alzheimer's disease : JAD 20180101 1


<h4>Background</h4>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.<h4>Objective</h4>We hypothesized that improved ascertainment and resulting decrease in disease severity at the time of diagnosis are responsible for this phenomenon.<h4>Methods</h4>Using Medicare data linked to the Health and Retirement Study (1992-2012), we performed a joint analysi  ...[more]

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