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Neurology and Therapy

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Open Access 31-05-2023 | Alzheimer's Disease | ORIGINAL RESEARCH

Estimating Transition Probabilities Across the Alzheimer’s Disease Continuum Using a Nationally Representative Real-World Database in the United States

Authors: Amir Abbas Tahami Monfared, Shuai Fu, Noemi Hummel, Luyuan Qi, Aastha Chandak, Raymond Zhang, Quanwu Zhang

Published in: Neurology and Therapy | Issue 4/2023

Abstract

Introduction

Clinical Alzheimer’s disease (AD) begins with mild cognitive impairment (MCI) and progresses to mild, moderate, or severe dementia, constituting a disease continuum that eventually leads to death. This study aimed to estimate the probabilities of transitions across those disease states.

Methods

We developed a mixed-effects multi-state Markov model to estimate the transition probabilities, adjusted for 5 baseline covariates, using the Health and Retirement Study (HRS) database. HRS surveys older adults in the United States bi-annually. Alzheimer states were defined using the modified Telephone Interview of Cognitive Status (TICS-m).

Results

A total of 11,292 AD patients were analyzed. Patients were 70.8 ± 9.0 years old, 54.9% female, and with 12.0 ± 3.3 years of education. Within 1 year from the initial state, the model estimated a higher probability of transition to the next AD state in earlier disease: 12.8% from MCI to mild AD and 5.0% from mild to moderate AD, but < 1% from moderate to severe AD. After 10 years, the probability of transition to the next state was markedly higher for all states, but still higher in earlier disease: 29.8% from MCI to mild AD, 23.5% from mild to moderate AD, and 5.7% from moderate to severe AD. Across all AD states, the probability of transition to death was < 5% after 1 year and > 15% after 10 years. Older age, fewer years of education, unemployment, and nursing home stay were associated with a higher risk of disease progression (p < 0.01).

Conclusions

This analysis shows that the risk of progression is greater in earlier AD states, increases over time, and is higher in patients who are older, with fewer years of education, unemployed, or in a nursing home at baseline. The estimated transition probabilities can provide guidance for future disease management and clinical trial design optimization, and can be used to refine existing cost-effectiveness frameworks.

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Title: Estimating Transition Probabilities Across the Alzheimer’s Disease Continuum Using a Nationally Representative Real-World Database in the United States
Authors: Amir Abbas Tahami Monfared
Shuai Fu
Noemi Hummel
Luyuan Qi
Aastha Chandak
Raymond Zhang
Quanwu Zhang
Publication date: 31-05-2023
Publisher: Springer Healthcare
Keywords: Alzheimer's Disease
Alzheimer's Disease
Mild Neurocognitive Disorder
Published in: Neurology and Therapy / Issue 4/2023
Print ISSN: 2193-8253
Electronic ISSN: 2193-6536
DOI: https://doi.org/10.1007/s40120-023-00498-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Estimating Transition Probabilities Across the Alzheimer’s Disease Continuum Using a Nationally Representative Real-World Database in the United States

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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