However, uncertainty surrounding the accurate assessment of the early stage or “mild” AD may limit the selection of patients to appropriate care.Īssessment of AD disease severity in clinical practice is often based on clinician’s subjective judgement as well as objective instruments such as the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). Īnti-amyloid therapies have been explored for patients with mild cognitive impairment (MCI) or mild dementia stage AD. The cost of care for AD in the USA alone is estimated to be well over $300 billion US dollars (USD), with the global societal cost of dementia exceeding $1 trillion USD. The experience of each individual patient with AD is a horrible tragedy for both the patient and their family. These data indicate a critical need for improved understanding of clinical assessments and decision-making to identify appropriate patients for anti-amyloid therapy.Īlzheimer’s disease (AD) is a progressive neurodegenerative disorder affecting an estimated 6.5 million Americans aged older than 65 years, and over 30 million people globally. Discordance is especially high for the subjectively assessed mild AD cohort where objective assessments showed a higher severity level in 40% of notes. We found higher concordance between clinician’s assessment and test-based assessment of Alzheimer’s disease severity in dementia specialty clinics. The proportion of concordant notes was higher in visits to dementia (61%) instead of non-dementia clinics (53%). Concordance varied about 21–73%, 47–58%, and 40–64% across symptoms/comorbidities, clinician types, and Veteran’s Integrated Service Networks, respectively. In the mild Alzheimer’s cohort, patients were assessed to have more severe disease by objective test scores in 40% of notes. Subjective and objective assessments were concordant in approximately half (53%) of overall notes. ResultsĪ total of 8888 notes were initially extracted the final analysis sample included 7514 notes corresponding to 4469 unique patients (mean age of 78 years 96.5% male 77.8% White). Concordance was assessed over time and by selected symptoms and comorbidities, as well as healthcare system factors. Using clinician-defined severity cohorts, we determined concordance between the clinician’s (subjective) assessments and the test-derived (objective) assessments of AD severity. Veterans who had mild, moderate, or severe AD with clinical notes documenting both clinician’s judgement of AD severity and objective test scores from the Mini-Mental State Examination or the Montreal Cognitive Assessment were included. To analyze clinical assessments of patients with AD in the Veteran’s Affairs (VA) Healthcare System and evaluate concordance between subjective and objective assessments, we processed clinical notes extracted by text integration utilities between April 1, 2008 and October 14, 2021. Uncertainty surrounding the accurate assessment of the early-stage Alzheimer’s disease (AD) may cause delayed care and inappropriate patient access to new AD therapies.
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