{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T07:22:35Z","timestamp":1787728955622,"version":"build-2784847793"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2025,1,17]],"date-time":"2025-01-17T00:00:00Z","timestamp":1737072000000},"content-version":"vor","delay-in-days":16,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["P30AG066589"],"award-info":[{"award-number":["P30AG066589"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Center for Advancing Sociodemographic and Economic Study of Alzheimer\u2019s Disease and Related Dementias","award":["P30AG043073"],"award-info":[{"award-number":["P30AG043073"]}]},{"name":"USC AD\/ADRD Resource Center for Minority Aging Research"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,3,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background and Objectives<\/jats:title>\n                  <jats:p>This study provides the first analysis of heterogeneity in health care use and costs by level of dementia symptom severity around the time of incident dementia diagnosis for a population-representative sample of older Americans.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Research Design and Methods<\/jats:title>\n                  <jats:p>We used the Aging, Demographics, and Memory Study (ADAMS), the Health Retirement Study (HRS), and traditional Medicare (TM) claims. We modeled dementia severity measured by the Clinical Dementia Rating scale for ADAMS respondents and applied parameter estimates to HRS respondents older than 70 years who had a claims-based incident dementia diagnosis in 2000\u20132016. We used claims-based measures of health care costs and use and quantified levels in the quarters before, at, and after a dementia diagnosis. We reported separate results for groups of persons diagnosed at mild, moderate, and severe stages of dementia.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Health care use and costs increased a quarter before dementia diagnosis and increased most significantly in the quarter of diagnosis. Both use and costs declined thereafter but remained elevated relative to prediagnosis. This general pattern was consistent for persons diagnosed at different stages of dementia. Acute care costs were similar across dementia severity categories throughout the period, whereas outpatient use and costs were consistently higher among persons diagnosed at mild stage disease.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion and Implications<\/jats:title>\n                  <jats:p>Findings from this study provide new insights on how heterogeneity of dementia severity at diagnosis is associated with health care use and costs. Under the current system of care in TM, early dementia diagnosis may not substantially reduce health care use and spending around the time of dementia diagnosis.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/geroni\/igaf005","type":"journal-article","created":{"date-parts":[[2025,1,17]],"date-time":"2025-01-17T10:36:18Z","timestamp":1737110178000},"source":"Crossref","is-referenced-by-count":2,"title":["Association of Dementia Severity at Diagnosis With Health Care Utilization and Costs Around the Time of Incident Diagnosis"],"prefix":"10.1093","volume":"9","author":[{"given":"Shengjia","family":"Xu","sequence":"first","affiliation":[{"name":"Price School of Public Policy, University of Southern California , Los Angeles, California,","place":["USA"]},{"name":"Schaeffer Center, University of Southern California , Los Angeles, California,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niloofar","family":"Fouladi Nashta","sequence":"additional","affiliation":[{"name":"Schaeffer Center, University of Southern California , Los Angeles, California,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Chen","sequence":"additional","affiliation":[{"name":"Rush Alzheimer\u2019s Disease Center, Rush University , Chicago, Illinois,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Zissimopoulos","sequence":"additional","affiliation":[{"name":"Price School of Public Policy, University of Southern California , Los Angeles, California,","place":["USA"]},{"name":"Schaeffer Center, University of Southern California , Los Angeles, California,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,1,17]]},"reference":[{"issue":"4","key":"2025031710464027700_CIT0001","doi-asserted-by":"publisher","first-page":"1598","DOI":"10.1002\/alz.13016","article-title":"Alzheimer\u2019s disease facts and figures","volume":"19","author":"Alzheimer\u2019s","year":"2023","journal-title":"Alzheimer\u2019s & Dementia"},{"key":"2025031710464027700_CIT0002","doi-asserted-by":"publisher","first-page":"1131","DOI":"10.1007\/s11606-018-4377-y","article-title":"Underdiagnosis of dementia: An observational study of patterns in diagnosis and awareness in US older adults","volume":"33","author":"Amjad","year":"2018","journal-title":"Journal of General Internal Medicine"},{"issue":"1","key":"2025031710464027700_CIT0003","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1186\/1471-2377-14-101","article-title":"Early intervention in Alzheimer\u2019s disease: A health economic study of the effects of diagnostic timing","volume":"14","author":"Barnett","year":"2014","journal-title":"BMC Neurology"},{"issue":"2","key":"2025031710464027700_CIT0004","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1111\/j.1532-5415.2004.52054.x","article-title":"The relationship between a dementia diagnosis, chronic illness, Medicare expenditures, and hospital use","volume":"52","author":"Bynum","year":"2004","journal-title":"Journal of the American Geriatrics Society"},{"key":"2025031710464027700_CIT0005","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1016\/j.trci.2019.04.003","article-title":"Analysis of dementia in the US population using Medicare claims: Insights from linked survey and administrative claims data","volume":"5","author":"Chen","year":"2019","journal-title":"Alzheimer's & Dementia"},{"issue":"1","key":"2025031710464027700_CIT0006","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1002\/alz.12657","article-title":"Public spending on acute and long-term care for","volume":"19","author":"Coe","year":"2023","journal-title":"Alzheimer\u2019s & Dementia"},{"key":"2025031710464027700_CIT0007","doi-asserted-by":"publisher","DOI":"10.1177\/0046958017696757","article-title":"Medicare expenditures associated with hospital and emergency department use among beneficiaries with dementia","volume":"54","author":"Daras","year":"2017","journal-title":"INQUIRY: The Journal of Health Care Organization, Provision, and Financing"},{"key":"2025031710464027700_CIT0008","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1016\/j.dadm.2018.12.005","article-title":"Trends in health service use and potentially avoidable hospitalizations before Alzheimer\u2019s disease diagnosis: A matched, retrospective study of US Medicare beneficiaries","volume":"11","author":"Desai","year":"2019","journal-title":"Alzheimer\u2019s & Dementia"},{"issue":"3","key":"2025031710464027700_CIT0009","doi-asserted-by":"publisher","first-page":"e12472","DOI":"10.1002\/dad2.12472","article-title":"Estimates of diagnosed dementia prevalence and incidence among diverse beneficiaries in traditional Medicare and Medicare Advantage","volume":"15","author":"Haye","year":"2023","journal-title":"Alzheimer's & Dementia"},{"issue":"9","key":"2025031710464027700_CIT0010","doi-asserted-by":"publisher","first-page":"2592","DOI":"10.1111\/jgs.17835","article-title":"Medicare spending associated with a dementia diagnosis among older adults","volume":"70","author":"Hoffman","year":"2022","journal-title":"Journal of the American Geriatrics Society"},{"issue":"6","key":"2025031710464027700_CIT0011","doi-asserted-by":"publisher","first-page":"1856","DOI":"10.1111\/jgs.18570","article-title":"Health care utilization before and after a dementia diagnosis in Medicare Advantage versus traditional Medicare","volume":"72","author":"Jacobson","year":"2023","journal-title":"Journal of the American Geriatrics Society"},{"key":"2025031710464027700_CIT0012","doi-asserted-by":"publisher","first-page":"S7","DOI":"10.2307\/146277","article-title":"An overview of the Health and Retirement Study","volume":"30","author":"Juster","year":"1995","journal-title":"Journal of Human Resources"},{"issue":"4","key":"2025031710464027700_CIT0013","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1016\/j.jamda.2019.09.012","article-title":"Dementia severity associated with increased risk of potentially preventable readmissions during home health care","volume":"21","author":"Knox","year":"2020","journal-title":"Journal of the American Medical Directors Association"},{"issue":"2","key":"2025031710464027700_CIT0014","doi-asserted-by":"publisher","first-page":"e0148779","DOI":"10.1371\/journal.pone.0148779","article-title":"Economic impact of dementia by disease severity: Exploring the relationship between stage of dementia and cost of care in Taiwan","volume":"11","author":"Ku","year":"2016","journal-title":"PLoS One"},{"issue":"6","key":"2025031710464027700_CIT0015","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1016\/j.jamda.2016.02.011","article-title":"Patterns of emergency department use among long-stay nursing home residents with differing levels of dementia severity","volume":"17","author":"LaMantia","year":"2016","journal-title":"Journal of the American Medical Directors Association"},{"issue":"1","key":"2025031710464027700_CIT0016","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1097\/WAD.0000000000000118","article-title":"Emergency department use among older adults with dementia","volume":"30","author":"LaMantia","year":"2016","journal-title":"Alzheimer Disease & Associated Disorders"},{"issue":"4","key":"2025031710464027700_CIT0017","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1159\/000087448","article-title":"The aging, demographics, and memory study: Study design and methods","volume":"25","author":"Langa","year":"2005","journal-title":"Neuroepidemiology"},{"issue":"5","key":"2025031710464027700_CIT0018","doi-asserted-by":"publisher","first-page":"384","DOI":"10.1111\/j.1600-0447.2011.01741.x","article-title":"Net costs of dementia by disease stage","volume":"124","author":"Leicht","year":"2011","journal-title":"Acta Psychiatrica Scandinavica"},{"issue":"8","key":"2025031710464027700_CIT0019","doi-asserted-by":"publisher","first-page":"679","DOI":"10.1097\/MLR.0000000000001577","article-title":"Dementia diagnosis disparities by race and ethnicity","volume":"59","author":"Lin","year":"2021","journal-title":"Medical Care"},{"issue":"8","key":"2025031710464027700_CIT0020","doi-asserted-by":"publisher","first-page":"1549","DOI":"10.1111\/jgs.14227","article-title":"Medicare Expenditures of individuals with Alzheimer\u2019s disease and related dementias or mild cognitive impairment before and after diagnosis","volume":"64","author":"Lin","year":"2016","journal-title":"Journal of the American Geriatrics Society"},{"issue":"8","key":"2025031710464027700_CIT0021","doi-asserted-by":"publisher","first-page":"655","DOI":"10.1007\/s12603-010-0312-6","article-title":"Alzheimer\u2019s disease: The strength of association of costs with different measures of disease severity","volume":"14","author":"Mauskopf","year":"2010","journal-title":"Journal of Nutrition, Health and Aging"},{"key":"2025031710464027700_CIT0022","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1007\/s10198-017-0869-7","article-title":"Healthcare utilization and costs in primary care patients with dementia: Baseline results of the DelpHi-trial","volume":"19","author":"Michalowsky","year":"2018","journal-title":"European Journal of Health Economics"},{"issue":"11","key":"2025031710464027700_CIT0023","doi-asserted-by":"publisher","first-page":"2412","DOI":"10.1212\/wnl.43.11.2412-a","article-title":"The Clinical Dementia Rating (CDR): Current version and scoring rules","volume":"43","author":"Morris","year":"1993","journal-title":"Neurology"},{"issue":"2","key":"2025031710464027700_CIT0024","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1001\/jama.2011.1964","article-title":"Association of incident dementia with hospitalizations","volume":"307","author":"Phelan","year":"2012","journal-title":"Journal of the American Medical Association"},{"issue":"3","key":"2025031710464027700_CIT0025","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1016\/j.jval.2012.02.003","article-title":"Exploring the relationship between Alzheimer\u2019s disease severity and longitudinal costs","volume":"15","author":"Rapp","year":"2012","journal-title":"Value in Health"},{"issue":"6","key":"2025031710464027700_CIT0026","doi-asserted-by":"publisher","first-page":"827","DOI":"10.1016\/j.jval.2011.04.005","article-title":"Costs of care for dementia patients in community setting: An analysis for mild and moderate disease stage","volume":"14","author":"Schwarzkopf","year":"2011","journal-title":"Value in Health"},{"issue":"8","key":"2025031710464027700_CIT0027","doi-asserted-by":"publisher","first-page":"782","DOI":"10.1097\/MLR.0000000000000753","article-title":"Using self-reports or claims to assess disease prevalence: It\u2019s complicated","volume":"55","author":"St Clair","year":"2017","journal-title":"Medical Care"},{"issue":"1","key":"2025031710464027700_CIT0028","doi-asserted-by":"publisher","first-page":"29","DOI":"10.3233\/JAD-190310","article-title":"Measuring Alzheimer\u2019s disease and other dementias in diverse populations using Medicare claims data","volume":"72","author":"Thunell","year":"2019","journal-title":"Journal of Alzheimer's Disease"},{"issue":"4","key":"2025031710464027700_CIT0029","doi-asserted-by":"publisher","first-page":"773","DOI":"10.1111\/1475-6773.13134","article-title":"Medicare expenditures attributable to dementia","volume":"54","author":"White","year":"2019","journal-title":"Health Services Research"},{"issue":"3","key":"2025031710464027700_CIT0030","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1017\/S1041610218000960","article-title":"Preventable hospitalizations among older patients with cognitive impairments and dementia","volume":"31","author":"Wolf","year":"2019","journal-title":"International Psychogeriatrics"},{"issue":"3","key":"2025031710464027700_CIT0031","doi-asserted-by":"publisher","first-page":"e12491","DOI":"10.1002\/trc2.12491","article-title":"Dementia severity at incident diagnosis in a population representative sample of older Americans","volume":"10","author":"Xu","year":"2024","journal-title":"Alzheimer's & Dementia"},{"issue":"11","key":"2025031710464027700_CIT0033","doi-asserted-by":"publisher","first-page":"1448","DOI":"10.1093\/gerona\/glv124","article-title":"Medicare utilization and expenditures around incident dementia in a multiethnic cohort","volume":"70","author":"Zhu","year":"2015","journal-title":"Journals of Gerontology, Series A: Biological Sciences and Medical Sciences"},{"issue":"5","key":"2025031710464027700_CIT0034","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1159\/000164797","article-title":"Patient dependence and longitudinal changes in costs of care in Alzheimer\u2019s disease","volume":"26","author":"Zhu","year":"2008","journal-title":"Dementia and Geriatric Cognitive Disorders"},{"issue":"1","key":"2025031710464027700_CIT0035","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1515\/fhep-2014-0013","article-title":"The value of delaying Alzheimer\u2019s disease onset","volume":"18","author":"Zissimopoulos","year":"2014","journal-title":"Forum for Health Economics and Policy"}],"container-title":["Innovation in Aging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/innovateage\/advance-article-pdf\/doi\/10.1093\/geroni\/igaf005\/61477815\/igaf005.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/innovateage\/article-pdf\/9\/3\/igaf005\/61477815\/igaf005.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/innovateage\/article-pdf\/9\/3\/igaf005\/61477815\/igaf005.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,17]],"date-time":"2025-03-17T10:47:02Z","timestamp":1742208422000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/innovateage\/article\/doi\/10.1093\/geroni\/igaf005\/7959352"}},"subtitle":[],"editor":[{"given":"Christine E","family":"Bishop","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025]]},"references-count":34,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,3,7]]}},"URL":"https:\/\/doi.org\/10.1093\/geroni\/igaf005","relation":{},"ISSN":["2399-5300"],"issn-type":[{"value":"2399-5300","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025]]},"published":{"date-parts":[[2025]]},"article-number":"igaf005"}}