An examination of Alzheimer's disease case definitions using Medicare claims and survey data

Lin, Pei Jung; Kaufer, Daniel I.; Maciejewski, Matthew L.; Ganguly, Rahul; Paul, John E.; Biddle, Andrea K.

doi:10.1016/j.jalz.2009.09.001

Cited by 71 publications

(80 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The prevalence of HIVassociated dementia may be as high as 2% across all ranges, whereas the risk of Alzheimer's disease and related dementias is 5% for all individuals over the age of 65. 15 Having a measure such as the CAMCI available for use by the clinicians could potentially increase the rate of diagnosis of dementia syndromes (see, for example, Lin and colleagues 16 ). The data available so far on the CAMCI 13 suggest that with availability of an appropriate normative sample, this screening tool could have great utility in clinical and research settings.…”

Section: Discussionmentioning

confidence: 99%

Concurrent Validity of a Computer-Based Cognitive Screening Tool for Use in Adults with HIV Disease

Becker

Dew²,

Aizenstein³

et al. 2011

AIDS Patient Care and STDs

View full text Add to dashboard Cite

As the incidence of HIV-associated dementia has decreased, the survival of HIV-infected individuals with milder forms of cognitive impairment has increased. Detecting this milder impairment in its earliest stages has great clinical and research importance. We report here the results of an initial evaluation of the Computer Assessment of Mild Cognitive Impairment (CAMCI Ò ), a computerized screening tool designed to assess abnormal cognitive decline with reduced respondent and test administrator burden. Fifty-nine volunteers (29 HIV infected; age = 50.9 years; education = 14.9 years; 36/59 males) completed the CAMCI Ò and a battery of neuropsychological tests. The CAMCI was repeated 12 and 24 weeks later. The results from the CAMCI were compared to Global and Domain Impairment scores derived from the full neuropsychological test battery. The CAMCI detected mild impairment (compared with normal and borderline test performance) with a sensitivity of 0.72, specificity of 0.97, positive predictive rate of 0.93, and a negative predictive rate of 0.89. Median stability over 12 and 24 weeks of follow-up was 0.32 and 0.46, respectively. These rates did not differ as a function of serostatus. A discriminant function analysis correctly classified 90% of the subjects with respect to their overall Global Impairment Rating from six of the CAMCI scores. This preliminary study demonstrates that the CAMCI is sensitive to mild forms of cognitive impairment, and is stable over 24 weeks of follow-up. A larger trial to obtain risk-group appropriate normative data will be necessary to make the instrument useful in both clinical practice and research (e.g., clinical trials).

show abstract

Section: Discussionmentioning

confidence: 99%

Concurrent Validity of a Computer-Based Cognitive Screening Tool for Use in Adults with HIV Disease

Becker

Dew²,

Aizenstein³

et al. 2011

AIDS Patient Care and STDs

View full text Add to dashboard Cite

show abstract

“…Patients needed one outpatient or inpatient claim with dementia in 2012 to be considered to have the condition. 30, 31 We restricted study patients to those who had a claims diagnosis of dementia (N = 2,657,648 patients), lived in the community (631,544 patients excluded with greater than 100 nursing home days according to Minimum Dataset), survived the entire year (207,028 patients excluded who died), and had at least 4 outpatient visits in 2012 to allow for calculation of the continuity measure (402,707 patients excluded with less than 4 visits). All remaining patients were included in the study (1,416,369 patients).…”

Section: Methodsmentioning

confidence: 99%

Continuity of Care and Health Care Utilization in Older Adults With Dementia in Fee-for-Service Medicare

et al. 2016

View full text Add to dashboard Cite

“…However, reliance on diagnosis codes from billing data to identify dementia has serious limitations, and important biases have been demonstrated. [16-18]…”

Section: Introductionmentioning

confidence: 99%

Direct medical costs and source of cost differences across the spectrum of cognitive decline: A population‐based study

Leibson

Long²,

Ransom

et al. 2015

Alzheimer's & Dementia

View full text Add to dashboard Cite

BACKGROUND Objective cost estimates and source of cost differences are needed across the spectrum of cognition, including cognitively normal (CN), mild-cognitive-impairment (MCI), newly-discovered dementia, and prevalent dementia. METHODS Subjects were a subset of the Mayo Clinic Study of Aging stratified-random sampling of Olmsted County, MN, residents aged 70-89 years. A neurologist reviewed provider-linked medical records to identify prevalent-dementia (review date=index). Remaining subjects were invited to participate in prospective clinical/neuropsychological assessments; participants were categorized as CN, MCI, or newly-discovered-dementia (assessment date=index). Costs for medical services/procedures 1-year pre-index (excluding indirect and long-term care costs) were estimated using line-item provider-linked administrative data. We estimated contributions of care-delivery site and comorbid conditions (including and excluding neuropsychiatric diagnoses) to between-category cost differences. RESULTS Annual mean medical costs for CN, MCI, newly-discovered-dementia, and prevalent-dementia were $6,042, $6,784, $9,431, $11,678 respectively. Hospital inpatient costs contributed 70% of total costs for prevalent dementia and accounted for differences between CN and both prevalent and newly-discovered dementia. Ambulatory costs accounted for differences between CN and MCI. Age-, sex-, education-adjusted differences reached significance for CN versus newly-discovered and prevalent-dementia and for MCI versus prevalent-dementia. After considering all comorbid diagnoses, between-category differences were reduced (e.g., prevalent-dementia minus MCI (from $4,842 to $3,575); newly-discovered-dementia minus CN (from $3,578 to$711). Following exclusion of neuropsychiatric diagnoses from comorbidity adjustment, between-category differences tended to revert to greater differences. CONCLUSIONS Cost estimates did not differ significantly between CN and MCI. Substantial differences between MCI and prevalent dementia reflected high inpatient costs for dementia and appear partly related to co-occurring Mental Disorders. Such comparisons can help inform models aimed at identifying where, when, and for which individuals proposed interventions might be cost-effective.

show abstract

An examination of Alzheimer's disease case definitions using Medicare claims and survey data

Cited by 71 publications

References 26 publications

Concurrent Validity of a Computer-Based Cognitive Screening Tool for Use in Adults with HIV Disease

Concurrent Validity of a Computer-Based Cognitive Screening Tool for Use in Adults with HIV Disease

Continuity of Care and Health Care Utilization in Older Adults With Dementia in Fee-for-Service Medicare

Direct medical costs and source of cost differences across the spectrum of cognitive decline: A population‐based study

Contact Info

Product

Resources

About