Objective:

To investigate frequency of and characteristics associated with Alzheimer's Disease (AD) treatment initiation before receiving an AD diagnosis.

   
 

 

 

 

 

Background:

AD is a neurodegenerative disorder with a potentially lengthy and challenging diagnosis process. Receiving an AD diagnosis may lead to certain restrictions and reporting requirements for patients and families. Hence, physicians may initiate cholinesterase inhibitors as a first-line treatment to slow progression prior to recording an AD diagnosis.

Design/Methods:

Commercial and Medicare Advantage Prescription Drug enrollees in the Optum’s de-identified Clinformatics® Data Mart Database with ≥2 pharmacy or medical claims for brand or generic donepezil or rivastigmine during 01 January 2019 - 31 December 2021 (date of first claim=index date), age ≥18, continuous enrollment 6 months prior to (baseline) and at least 12 months following (follow-up) index date, and no claims for either medication in baseline were included. Patients were stratified into AD-diagnosis vs. no-AD diagnosis cohorts based on having ≥1 AD diagnosis in baseline or at index.  Patient age, sex, race/ethnicity, dementia-related conditions, and time to AD diagnosis were evaluated.

Results:

Among 299,018 patients with ≥1 claim for donepezil or rivastigmine, 58,997 met full selection criteria. The study population had mean age of 78.3 (SD: 7.47) years, were majority female (60.8%), and were approximately 68% Caucasian. Commonly diagnosed dementia-related conditions in baseline or at index were mild cognitive impairment (50.0%), general/unspecified dementia (47.9%), and vascular dementia (7.1%). Among treatment initiators only 21.1%% patients had an AD diagnosis compared with 78.9% without an AD diagnosis in baseline or at index. Mean time to AD diagnosis from treatment initiation was 12.1 (median: 7.9) months.

Conclusions:

These results highlight that most AD patients are initiated on treatment ahead of diagnosis. These findings are especially important considering new AD therapeutics that would likely have stringent prior authorization criteria linked to an existing AD diagnosis.