Employment, volunteering, and health-related resource use in pre-symptomatic AD: Results from the Anti-Amyloid Treatment in Asymptomatic Alzheimer's Disease (A4) study

IF 11.1 1区医学 Q1 CLINICAL NEUROLOGY

Alzheimer's & Dementia Pub Date : 2025-10-14 DOI:10.1002/alz.70641

Carolyn W. Zhu, Charlene Flournoy, Rema Raman, Mary Sano

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Abstract

INTRODUCTION

Little is known about productive time use and health-related resource use during “pre-symptomatic” AD, defined by the presence of brain amyloid in the absence of cognitive symptoms. We compared changes in resource use and participation in paid employment and/or volunteering in cognitively unimpaired older adults with amyloid accumulation (Anti-Amyloid Treatment in Asymptomatic Alzheimer's Disease [A4] study, N = 1165) to otherwise matched participants without amyloid accumulation (Longitudinal Evaluation of Amyloid Risk and Neurodegeneration [LEARN] study, N = 507).

METHODS

Health-related resource use was self-reported using the Resource Use Inventory (RUI). Longitudinal analyses examined effect on RUI from study (A4 vs LEARN), time, and their interaction, controlling for Alzheimer's Disease Cooperative Study-Preclinical Alzheimer's Cognitive Composite (ADCS-PACC) and the Clinical Dementia Rating (CDR) scale, and their change scores from baseline.

RESULTS

Over time, paid employment and volunteering decreased, and unpaid help and hospitalization increased. Results showed clear associations between ADCS-PACC and CDR with RUI.

DISCUSSION

Little detectable impact of amyloid levels on RUI was found in pre-symptomatic AD that has been identified as an ideal stage to target for dementia prevention.

Highlights

Using data from a cohort of cognitively unimpaired older adults with evidence of amyloid accumulation enrolled in the Anti-Amyloid Treatment in Asymptomatic Alzheimer's Disease (A4) study and otherwise matched participants who did not meet subthreshold levels of amyloid accumulation enrolled in the Longitudinal Evaluation of Amyloid Risk and Neurodegeneration (LEARN) study, this study showed clear associations between clinical variables and resource use and participation in paid employment and volunteering but suggested little detectable impact of amyloid levels on rate of change during the preclinical stage.
Our results suggest that economic benefits from currently available treatment that effectively removes amyloid may not be immediately or concurrently observed during the short timeline of clinical trials.
It is critical that our examination of economic consequence of treatment include broad ranges of items on resource use and productivity loss, longer time horizon, and that we balance between cost of detection, treatment, and burden and benefit.

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无症状阿尔茨海默病抗淀粉样蛋白治疗（A4）研究的结果：症状前阿尔茨海默病的就业、志愿服务和健康相关资源使用

在“症状前”AD（指在没有认知症状的情况下脑淀粉样蛋白的存在）期间，人们对生产时间的使用和健康相关资源的使用知之甚少。我们比较了有淀粉样蛋白积累的认知功能正常的老年人（无症状阿尔茨海默病抗淀粉样蛋白治疗[A4]研究，N = 1165）和没有淀粉样蛋白积累的其他匹配参与者（淀粉样蛋白风险和神经变性的纵向评估[LEARN]研究，N = 507）在资源使用和参与有偿就业和/或志愿服务方面的变化。方法采用资源使用量表（resource use Inventory， RUI）自我报告健康相关资源使用情况。纵向分析检验了研究（A4 vs LEARN）、时间及其相互作用对RUI的影响，控制了阿尔茨海默病合作研究-临床前阿尔茨海默病认知复合（ADCS - PACC）和临床痴呆评分（CDR）量表，以及它们从基线开始的变化得分。结果随时间推移，有偿就业和志愿服务减少，无偿帮助和住院治疗增加。结果显示ADCS - PACC和CDR与RUI之间存在明显的相关性。在症状前AD中，淀粉样蛋白水平对RUI几乎没有可检测到的影响，而症状前AD已被确定为预防痴呆的理想阶段。研究数据来自无症状阿尔茨海默病抗淀粉样蛋白治疗（A4）研究中有淀粉样蛋白积累证据的认知功能未受损的老年人队列，以及淀粉样蛋白风险和神经变性纵向评估（LEARN）研究中未达到淀粉样蛋白积累亚阈值水平的其他匹配参与者。这项研究表明，临床变量与资源使用、有偿就业和志愿服务的参与之间存在明显的关联，但在临床前阶段，淀粉样蛋白水平对变化率的影响很小。我们的研究结果表明，在短期的临床试验中，目前有效去除淀粉样蛋白的治疗方法可能无法立即或同时观察到经济效益。至关重要的是，我们对治疗的经济后果的审查应包括有关资源使用和生产力损失的广泛项目，更长的时间范围，并在检测成本、治疗成本以及负担和效益之间取得平衡。

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来源期刊

Alzheimer's & Dementia 医学-临床神经学

CiteScore

14.50

自引率

5.00%

发文量

299

审稿时长

3 months

期刊介绍： Alzheimer's & Dementia is a peer-reviewed journal that aims to bridge knowledge gaps in dementia research by covering the entire spectrum, from basic science to clinical trials to social and behavioral investigations. It provides a platform for rapid communication of new findings and ideas, optimal translation of research into practical applications, increasing knowledge across diverse disciplines for early detection, diagnosis, and intervention, and identifying promising new research directions. In July 2008, Alzheimer's & Dementia was accepted for indexing by MEDLINE, recognizing its scientific merit and contribution to Alzheimer's research.