TRENDS IN SUBJECTIVE MEMORY AND FUNCTIONAL LIMITATIONS IN THE UNITED STATES: A MATCHED CASE- CONTROL NHANES ANALYSIS

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1 1 TRENDS IN SUBJECTIVE MEMORY AND FUNCTIONAL LIMITATIONS IN THE UNITED STATES: A MATCHED CASE- CONTROL NHANES ANALYSIS Myrlene Sanon Aigbogun, MPH 1 Robert Stellhorn, 1 Holly Krasa, 1 Dusan Kostic 2 1 Health Outcomes Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ 2 Global Medical Affairs, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ Funding for this research was provided by Otsuka Pharmaceutical Development & Commercialization, Inc.

2 2 Background Dementia/ Alzheimer s Disease Dementia affects almost 50 million people worldwide Alzheimer s disease (AD) is the most prevalent form of dementia, affecting approximately 5.4 million Americans in Individual Reports Many individuals report subjective memory and functional complaints many years prior to the development of dementia and Alzheimer s disease 2,3 In 2012, a national survey estimated that in the United States 18.7% of noninstitutionalized individuals report limitations in mental or functional abilities. 4 Evidence Gaps Despite high and increasing numbers, published data on epidemiology, health care costs and real world reports on care are scarce Alzheimer s Disease Facts and Figures. April Alzheimer s Association. Alz.org. Accessed on June Mitchell AJ, Beaumont H, Ferguson D, Yadegarfar M, Stubbs B. Risk of dementia and mild cognitive impairment in older people with subjective memory complaints: meta-analysis. Acta Psychiatr Scand 2014; 130: Jessen F, Wiese B, Bachmann C, Eifflaender-Gorfer S, Haller F, Kölsch H, Luck T, Mösch E, van den Bussche H, Wagner M, Wollny A, Zimmermann T, Pentzek M, Riedel-Heller SG, Romberg HP, Weyerer S, Kaduszkiewicz H, Maier W, Bickel H; German Study on Aging, Cognition and Dementia in Primary Care Patients Study Group.Prediction of dementia by subjective memory impairment: effects of severity and temporal association with cognitive impairment. Arch Gen Psychiatry 2010; 67: Brault M. Americans with Disabilities: Current Population Reports. U.S. Department of Commerce Economics and Statistics Administration; US Census Bureau, 2012, pp

3 3 Objective This study evaluated the prevalence rate of cognitive and functional limitations as reported by individuals Specifically, the National Health and Nutrition Examination Survey (NHANES) was used to examine; Prevalence rate of cognitive and functional limitations Rates of healthcare resource utilization among cases versus matched controls

4 4 Methods: Data Sources Cross-sectional survey designed to assess the health and nutritional status of adults and children in the United States Unique in that it combines interviews and physical examinations Major program of the National Center for Health Statistics (NCHS) Survey examines a nationally representative sample of about 5,000 persons each year NHANES interview includes demographic, socioeconomic, dietary, and health-related questions; the examination component consists of medical, dental, and physiological measurements, as well as laboratory tests administered by highly trained medical personnel

5 5 Methods: Sample Selection Survey respondents from Aged 65 years or older Completed both Interview and Medical examination

6 6 Methods: Sample Identification Sample Definition Survey related item Cognitive Limitation Are you limited in any way because of difficulty remembering or because you experience periods of confusion? * Case Functional Limitation 3 functional domains Activities of daily living (eating/dressing) Instrumental activities of daily living (managing money, chores, preparing meals) Social interactions (social activities, meetings, parties, visiting friends) Control No positive responses to cognitive or functional limitation survey questions For each case with a limitation (cognitive/functional), using propensity scores 1 control participant was matched to a case based on age ±1 year, gender, race, education, individual comorbidity, and survey year *Previous using this question to evaluate cognitive limitations- Hajjar et al. Racial Disparity in Cognitive and Functional Disability in Hypertension and All-Cause Mortality. Am J Hypertens Jul 1. pii: hpv084

7 Methods: Statistical Analyses 7 Data analyzed using SAS and accounted for the nonrandom cluster sample design in calculating variance estimates Nationally representative estimates of the civilian, noninstitutionalized U.S. population were estimated using sample weights developed by the CDC Study measures include- Patient Demographics Concomitant Medications Anti-dementia Treatment Health Status Healthcare Resource Utilization

8 8 Results: Patient Characteristics 9,029 participants were available across the surveys 2,096 cases (23%) identified and 2,096 matched controls Mean age 75 years and 64% female for cases and controls Among cases with functional limitations- 56% 25% 74% Activities of daily living (i.e., eating, dressing) Instrumental activities of daily living (i.e., Managing money difficulty) Social interaction and activities (i.e., Attending social event difficulty) 25.2% of cases reported worsening health status over one year compared to 13.1% of controls (p < )

9 Results: Prevalence (%) of self-reported concomitant medications by group, Higher utilization of co-medications reported in cases vs controls, including antidepressants (22% vs 11%), hypnotics (13% vs 8%), opioids (12% vs 4%), and antipsychotics (3.5% vs. 0.6%) 9 25% 20% 15% 10% * * * * 5% 0% * cases controls

10 Results: Prevalence of anti-dementia treatment by group, Higher utilization of anti-dementia treatment in cases versus controls Rate of cholinesterase inhibitors and memantine use increasing over time Prevalence of anti-dementia use, by group 9% 8% 7% 6% 5% 4% 3% 2% 1% 0% Cases Controls Donepezil Rivastigmine galantamine Memantine

11 11 Results: Healthcare resource utilization Analyses showed significantly more (28.4% cases vs 18.2% controls) experienced overnight hospitalization in the last year (p<0.0001) Seeing a mental health specialist was also significantly higher in cases versus controls, 8.2% vs 2.5%, respectively, (p <0.0001)

12 12 Summary Survey findings provide an overview of the extent of memory & functional impairment in the US population over 65 years Higher rates of co-medications observed for cases versus matched controls along with greater use of healthcare resources Self-reported information is subject to recall bias and even more relevant in a population with memory complaints; notably self-reported health status is a common method to assess disability and also a predictor of morbidity and mortality 5,6 While surveys are subject to recall bias, this study provides comparative data on the burden associated with memory and functional limitations These nationally-representative frequency data provide a tremendous resource for future epidemiologic studies in public health in the United States 5) Centers for Disease C and Prevention. Racial/ethnic disparities in selfrated health status among adults with and without disabilities United States, MMWR 2008; 57: ). Lee SJ, Moody-Ayers SY, Landefeld CS, Walter LC, Lindquist K, Segal MR, Covinsky KE. The relationship between self-rated health and mortality in older black and white Americans. J Am Geriatr Soc 2007;55: