Real-world use of diagnostic tests for mild cognitive impairment, Alzheimer's disease, and other dementias in Medicare fee-for-service beneficiaries.

IF 4.4 Q1 CLINICAL NEUROLOGY
Jessie T Yan, Allison Dillon, Tong Meng, Viviktha Ramesh, Marwan Noel Sabbagh, Vishakha Sharma, Sophie Roth
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Abstract

Introduction: This study assessed real-world use of diagnostic tests, such as neuroimaging (e.g., magnetic resonance imaging [MRI], or positron emission tomography [PET]), and computed tomography (CT), cerebrospinal fluid (CSF) biomarker, and blood tests for mild cognitive impairment (MCI), Alzheimer's disease (AD), and other dementias in a large US elderly population.

Methods: Medicare fee-for-service data (2015-2020) were used to identify patients aged ≥ 67 newly diagnosed with MCI, AD, or other dementias. Descriptive analyses were conducted to understand the test use within 1 year before disease diagnosis and trends.

Results: Among 653,420 patients (9.1% MCI, 30.3% AD, 60.6% other dementias), 71.9% had blood tests, 53.9% neuroimaging (46.4% CT, 17.7% MRI, and 0.7% PET), and 2.2% CSF test. Test use slightly increased from 2015 to 2020.

Discussion: Findings from this study suggest low use of diagnostic tests, especially PET and CSF.

Highlights: Blood tests, magnetic resonance imaging, and computed tomography were predominant for diagnosing mild cognitive impairment, Alzheimer's disease, or other dementias prior to the arrival of disease-modifying therapies.Cerebrospinal fluid biomarker and positron emission tomography tests were infrequently used despite their diagnostic value.The study indicates a modest increase in diagnostic test usage over 6 years between 2015 and 2020.Patients often received combined or repeated diagnostic tests.

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在医疗服务收费受益人中,对轻度认知障碍、阿尔茨海默病和其他痴呆症的诊断测试的实际使用。
本研究评估了现实世界中诊断测试的使用情况,如神经影像学(如磁共振成像[MRI]或正电子发射断层扫描[PET])、计算机断层扫描(CT)、脑脊液(CSF)生物标志物和血液测试对美国大量老年人群轻度认知障碍(MCI)、阿尔茨海默病(AD)和其他痴呆症的检测。方法:使用2015-2020年医疗保险服务收费数据来识别年龄≥67岁的新诊断为MCI、AD或其他痴呆的患者。进行描述性分析以了解疾病诊断前1年内的检测使用情况及其趋势。结果:在653,420例患者中(9.1% MCI, 30.3% AD, 60.6%其他痴呆),71.9%进行血液检查,53.9%进行神经影像学检查(46.4% CT, 17.7% MRI, 0.7% PET), 2.2%进行CSF检查。从2015年到2020年,测试使用略有增加。讨论:本研究结果提示诊断测试的使用率较低,尤其是PET和CSF。重点:血液检查、磁共振成像和计算机断层扫描是诊断轻度认知障碍、阿尔茨海默病或其他痴呆症的主要方法,在疾病改善疗法到来之前。脑脊液生物标志物和正电子发射断层扫描试验尽管具有诊断价值,但很少使用。该研究表明,在2015年至2020年的6年间,诊断测试的使用略有增加。患者通常接受联合或重复的诊断检查。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
7.80
自引率
7.50%
发文量
101
审稿时长
8 weeks
期刊介绍: Alzheimer''s & Dementia: Diagnosis, Assessment & Disease Monitoring (DADM) is an open access, peer-reviewed, journal from the Alzheimer''s Association® that will publish new research that reports the discovery, development and validation of instruments, technologies, algorithms, and innovative processes. Papers will cover a range of topics interested in the early and accurate detection of individuals with memory complaints and/or among asymptomatic individuals at elevated risk for various forms of memory disorders. The expectation for published papers will be to translate fundamental knowledge about the neurobiology of the disease into practical reports that describe both the conceptual and methodological aspects of the submitted scientific inquiry. Published topics will explore the development of biomarkers, surrogate markers, and conceptual/methodological challenges. Publication priority will be given to papers that 1) describe putative surrogate markers that accurately track disease progression, 2) biomarkers that fulfill international regulatory requirements, 3) reports from large, well-characterized population-based cohorts that comprise the heterogeneity and diversity of asymptomatic individuals and 4) algorithmic development that considers multi-marker arrays (e.g., integrated-omics, genetics, biofluids, imaging, etc.) and advanced computational analytics and technologies.
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