{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:27:06Z","timestamp":1786976826901,"version":"build-2736575974"},"reference-count":45,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T00:00:00Z","timestamp":1764115200000},"content-version":"vor","delay-in-days":25,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["R01AI165535"],"award-info":[{"award-number":["R01AI165535"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["R01AG074372"],"award-info":[{"award-number":["R01AG074372"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["alz-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Alzheimer's &amp;amp; Dementia"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>INTRODUCTION<\/jats:title>\n                    <jats:p>Artificial intelligence (AI) models in healthcare require accurate diagnostic data. In dementia, diagnostic ambiguity and inconsistent coding may distort data quality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>This cohort study analyzed 2016 to 2018 Medicare Part A hospitalization claims across 3000+ U.S. counties. Seventeen International Classification of Diseases, 10th Revision dementia codes were grouped into five categories. Temporal patterns were modeled using the transitive sequential pattern mining (tSPM+) algorithm; matrix similarity and multivariable regression assessed geographic and demographic variation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Non\u2010specific codes were most common. Alzheimer's and vascular dementia codes showed high regional variability. Frequent transitions from specific to non\u2010specific codes indicated diagnostic signal decay. Counties with more rural, Medicaid\u2010eligible, and Black or Hispanic patients had lower alignment with national patterns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DISCUSSION<\/jats:title>\n                    <jats:p>Dementia documentation varies widely and systematically across the United States. Much of this reflects inconsistent diagnostic practices, not true disease differences. Signal decay introduces bias into claims\u2010based research and AI. Linking claims to validated cohorts may improve data quality and model fairness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>HIGHLIGHTS<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>Non\u2010specific dementia codes dominate Medicare hospitalization data.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Temporal analysis shows diagnostic signal decay over time.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Geographic variation is linked to rurality and racial demographics.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Signal decay poses bias risks for AI and claims\u2010based research.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Model explains 38% of variation in diagnostic pattern similarity.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/alz.70945","type":"journal-article","created":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T09:11:29Z","timestamp":1764148289000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Quantifying diagnostic signal decay in dementia: a national study of Medicare hospitalization data"],"prefix":"10.1002","volume":"21","author":[{"given":"Federica","family":"Spoto","sequence":"first","affiliation":[{"name":"Department of Biostatistics Harvard T.H. Chan School of Public Health  Boston Massachusetts USA"},{"name":"Department of Environmental Health Harvard T.H. 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