Evaluating linked ICD-10 Medicare claims data as a method of dementia case ascertainment in research settings.

Introduction: US Medicare claims can be used to identify dementia cases for research. Our objective was to evaluate the performance of International Classification of Diseases, 10th Revision (ICD-10) code definitions versus research-based dementia ascertainment.

Methods: Participants of five Rush Alzheimer's Disease Center (RADC) cohorts with study visits between October 2015 and December 2019 and fee-for-service Medicare contributed observations.

Case Definition for Diagnosed Alzheimer Disease and Related Dementias in Medicare.

Importance: Lack of a US dementia surveillance system hinders efforts to support and address disparities among persons living with Alzheimer disease and related dementias (ADRD).

Objective: To review diagnosis and prescription drug code ADRD identification algorithms to develop and implement case definitions for national surveillance.

Design, Setting, And Participants: In this cross-sectional study, a systematic literature review was conducted to identify unique International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and prescription drug codes used by researchers to identify ADRD in administrative records.

Risks and Benefits of Clinical Diagnosis Around the Time of Dementia Onset.

Diagnostic delay in dementia is common in the U.S. Drivers of diagnostic delay are poorly understood, but appear related to misconceptions about dementia, stigma, concerns about autonomy, the nature of the diagnostic process, and provider-related factors.

Association Between Racial Segregation and COVID-19 Vaccination Rates.

Objective: To examine the association between county-level Black-White residential segregation and COVID-19 vaccination rates.

Design: Observational cross-sectional study using multivariable generalized linear models with state fixed effects to estimate the average marginal effects of segregation on vaccination rates.

Setting: National analysis of county-level vaccination rates.

Medicare Hospice Policy Changes and Beneficiaries' Rate of Live Discharge and Length-of-Stay.

Context: The 2014 Improving Medicare Post-Acute Care Transformation (IMPACT) Act systemized audits of long hospice stays, and the 2016 two-tier payment system decreased daily reimbursement rates after 60 days of enrollment. Both aimed to reduce long stays.

Objectives: Examine how live discharge rates and length of stay changed in relation to the policies.

Investigation of the association of military employment and Parkinson's disease with a validated Parkinson's disease case-finding strategy.

Introduction: Persons with military involvement may be more likely to have Parkinson's disease (PD) risk factors. As PD is rare, case finding remains a challenge, contributing to our limited understanding of PD risk factors. Here, we explore the validity of case-finding strategies and whether military employment is associated with PD.

Evaluation of Federal Policy Changes to the Hospice Benefit and Use of Hospice for Persons With ADRD.

Importance: Hospice is an important end-of-life service for patients with Alzheimer disease and related dementias (ADRD).

Objective: To determine whether hospice use among patients with ADRD changed in association with recent policies aimed at reducing hospice misuse and long hospice stays, an outcome that may have disproportionately affected patients with ADRD because of their lengthy end-of-life trajectories.

Design Setting And Participants: This observational cross-sectional study used Medicare hospice claims data from Medicare hospice episodes of care beginning between July 2008 and December 2019 among Medicare hospice beneficiaries 65 years or older at time of enrollment.

Estimation of dementia prevalence at the local level in the United States.

Introduction: Ensuring adequate and equitable distribution of resources to support persons living with dementia relies on understanding the burden and distribution of dementia in a population. Our goal was to develop an approach to estimate dementia prevalence at the local level in the United States using publicly available data.

Methods: Our approach combines publicly available data on dementia prevalence and demographic data from the US Census to estimate dementia prevalence.

Association of Military Employment With Late-Life Cognitive Decline and Dementia: A Population-Based Prospective Cohort Study.

Introduction: As the number of U.S. veterans over age 65 has increased, interest in whether military service affects late-life health outcomes has grown.

Exposure to Air Pollution in Relation to Risk of Dementia and Related Outcomes: An Updated Systematic Review of the Epidemiological Literature.

Background: Dementia is a devastating neurologic condition that is common in older adults. We previously reviewed the epidemiological evidence examining the hypothesis that long-term exposure to air pollution affects dementia risk. Since then, the evidence base has expanded rapidly.

Generalizability of findings from a clinical sample to a community-based sample: A comparison of ADNI and ARIC.

Introduction: Clinic-based study samples, including the Alzheimer's Disease Neuroimaging Initiative (ADNI), offer rich data, but findings may not generalize to community-based settings. We compared associations in ADNI to those in the Atherosclerosis Risk in Communities (ARIC) study to assess generalizability across the two settings.

Methods: We estimated cohort-specific associations among risk factors, cognitive test scores, and neuroimaging outcomes to identify and quantify the extent of significant and substantively meaningful differences in associations between cohorts.

Trends in Relative Incidence and Prevalence of Dementia Across Non-Hispanic Black and White Individuals in the United States, 2000-2016.

Importance: In the US, dementia risk is higher in non-Hispanic Black individuals than in non-Hispanic White individuals. To evaluate progress toward reducing such disparities, tracking secular trends in racial disparities in dementia prevalence is essential.

Objective: To examine whether relative racial disparities in dementia prevalence or incidence have changed in the US from 2000 to 2016.

Implications of the Use of Algorithmic Diagnoses or Medicare Claims to Ascertain Dementia.

Introduction: Formal dementia ascertainment with research criteria is resource-intensive, prompting the growing use of alternative approaches. Our objective was to illustrate the potential bias and implications for study conclusions introduced through the use of alternate dementia ascertainment approaches.

Methods: We compared dementia prevalence and risk factor associations obtained using criterion-standard dementia diagnoses to those obtained using algorithmic or Medicare-based dementia ascertainment in participants of the baseline visit of the Aging, Demographics, and Memory Study (ADAMS), a Health and Retirement Study (HRS) sub-study.

The association between midlife lipid levels and late-life brain amyloid deposition.

Elevated low-density lipoprotein cholesterol and total cholesterol in midlife and decline in total cholesterol from mid- to late-life are associated with incident dementia. Whether brain amyloid deposition mediates this relationship is unclear. We explored the association between midlife blood lipid levels and mid- to late-life change in lipid levels with brain amyloid deposition assessed using florbetapir PET scans in a biracial sample of 325 nondemented participants of the Atherosclerosis Risk in Communities-PET Amyloid Imaging study.

Association of traumatic brain injury with dementia and memory decline in older adults in the United States.

Introduction: To examine associations of history of traumatic brain injuries (TBIs) with loss of consciousness (LOC) with dementia incidence and memory decline.

Methods: We studied 2718 participants from the 1992 enrollment cohort of the Health and Retirement Study (HRS) aged 65 years or older in 2000. History of TBI with LOC was self-reported in 1992.

Racial disparities and temporal trends in dementia misdiagnosis risk in the United States.

Introduction: Systematic disparities in misdiagnosis of dementia across racial/ethnic groups have implications for health disparities. We compared the risk of dementia under- and overdiagnosis in clinical settings across racial/ethnic groups from 2000 to 2010.

Methods: We linked fee-for-service Medicare claims to participants aged ≥70 from the nationally representative Health and Retirement Study.

Choosing between medical management and liver transplant in urea cycle disorders: A conceptual framework for parental treatment decision-making in rare disease.

Urea cycle disorders (UCD) are rare inherited metabolic disorders caused by deficiencies of enzymes and transporters required to convert neurotoxic ammonia into urea. These deficiencies cause elevated blood ammonia, which if untreated may result in death, but even with optimal medical management, often results in recurrent brain damage. There are two major treatments for UCD: medical management or liver transplantation.

Development of Algorithmic Dementia Ascertainment for Racial/Ethnic Disparities Research in the US Health and Retirement Study.

Background: Disparities research in dementia is limited by lack of large, diverse, and representative samples with systematic dementia ascertainment. Algorithmic diagnosis of dementia offers a cost-effective alternate approach. Prior work in the nationally representative Health and Retirement Study has demonstrated that existing algorithms are ill-suited for racial/ethnic disparities work given differences in sensitivity and specificity by race/ethnicity.

Self-Reported Hearing Loss and Nonfatal Fall-Related Injury in a Nationally Representative Sample.

Background/objective: To evaluate the relationship between self-reported hearing loss and nonfatal fall-related injury in a nationally representative sample of community-dwelling adults living in the United States.

Design: Cross-sectional analysis of national survey data.

Setting: National Health Interview Survey (2016).

Comparison of Methods for Algorithmic Classification of Dementia Status in the Health and Retirement Study.

Background: Dementia ascertainment is time-consuming and costly. Several algorithms use existing data from the US-representative Health and Retirement Study (HRS) to algorithmically identify dementia. However, relative performance of these algorithms remains unknown.