Researchers have yet to identify therapies that can reverse or slow the progression of Alzheimer's disease and related dementias (ADRD), but four prescription drugs (donepezil, galantamine, memantine, and rivastigmine) have been recommended in AD treatment guidelines, having shown effects on the symptoms of AD. Despite the potential of these drugs to at least partially reduce AD's burden, relatively little is known about the current trends in the use of these drugs within the trajectory of dementia diagnoses and care. This study examines these trends, with specific attention to disparities in drug use across sex, race, and ethnicity. Methods: Descriptive statistics of utilization of donepezil, galantamine, memantine, and rivastigmine in the Medicare claims data (2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014). We investigate variation in the timing of treatment initiation and overall utilization relative to different types of dementia diagnoses, patient characteristics, and relative to the specialty of the dementia-diagnosing physician. Results: In 2008-2013, approximately 73% of AD patients used at least one of the four drugs. Over the same period, the portion of newly diagnosed AD patients who initiated use within six months of index diagnosis rose from 25% to 33%. Black patients are less likely to use the drugs, compared to Whites, Hispanics, and Asians. Among Whites, males are more likely to use than females, but this is reversed for Blacks, Hispanics, and Asians. 51% of users with an AD diagnosis initiated use prior to their index AD diagnosis. 6% began drug use prior to any dementia or dementia symptom diagnosis. Approximately 3% of users of these drugs have never received a diagnosis for ADRD, or any related symptoms. Conclusions: Trends in timing and overall utilization of pharmaceutical treatments for AD could have major consequences on population health, particularly for racial and ethnic minorities that are disproportionately burdened by AD.
