@article {13553, title = {Declines in Wealth Among US Older Adults at Risk of Dementia.}, journal = {JAMA Neurology}, year = {Forthcoming}, abstract = {Dementia is a set of neurocognitive conditions marked by a gradual deterioration of cognitive capacity that interferes with daily life, with Alzheimer disease being the most common.1 This process may adversely affect household wealth, a key social determinant of health, due to negative outcomes of financial decision capacity2 and need for expensive medical and long-term care services.3,4 We compared trajectories in household wealth for older adults (aged >=65 years) who developed probable dementia with those of a control cohort without dementia. }, keywords = {Dementia, medical cost, Wealth}, issn = {2168-6157}, doi = {10.1001/jamaneurol.2023.3216}, author = {Li, Jing and Skinner, Jonathan S and Kathleen McGarry and Nicholas, Lauren Hersch and Wang, Shao-Pang and Bollens-Lund, Evan and Kelley, Amy S} } @article {13531, title = {Health care utilization and costs in the years preceding dementia identification.}, journal = {Alzheimer{\textquoteright}s \& Dementia: the journal of the Alzheimer{\textquoteright}s association}, year = {Forthcoming}, abstract = {

INTRODUCTION: There is evidence that health care utilization increases after incident dementia, particularly after dementia diagnosis and toward the end of life; however, less is known about utilization in the years before dementia identification.

METHODS: In this retrospective cohort study we obtained data on n~=~5547 beneficiaries from the Health and Retirement Study (HRS)-Medicare linked sample (n~=~1241 with and n~=~4306 without dementia) to compare longitudinal trends in health care costs and utilization in the 6 years preceding dementia identification relative to a confounder-balanced reference group without dementia.

RESULTS: We found that persons with dementia had a greater prevalence of outpatient emergency department (ED), inpatient hospital, skilled nursing, and home health use, and total health care costs in the years preceding dementia identification compared to their similar counterparts without dementia across a comparable timespan in later life.

CONCLUSIONS: This study provides evidence to suggest greater healthcare burden may exist well before clinical manifestation and identification of dementia.

HIGHLIGHTS: Several studies have documented the tremendous healthcare-related costs of living with dementia, particularly toward the end of life. Dementia is a progressive neurodegenerative disease, which, for some, includes a prolonged pre-clinical phase. However, health services research to date has seldom considered the time before incident dementia. This study documents that health care utilization and costs are significantly elevated in the years before incident dementia relative to a demographically-similar comparison group without dementia.

}, keywords = {Alzheimer{\textquoteright}s disease and related dementias, comorbidities, Epidemiology, Health Care Costs, Health care utilization, mild cognitive impairment}, issn = {1552-5279}, doi = {10.1002/alz.13476}, author = {Kumar, Raj G and Lund, Evan Bollens and Ornstein, Katherine A and Li, Jing and Covinsky, Kenneth E and Kelley, Amy S} } @article {13350, title = {Apolipoprotein E (APOE) genotype, dementia, and memory performance among Caribbean Hispanic versus US populations.}, journal = {Alzheimers Dement}, volume = {19}, year = {2023}, pages = {602-610}, abstract = {

INTRODUCTION: Apolipoprotein E (APOE) is considered the major susceptibility gene for developing Alzheimer{\textquoteright}s disease. However, the strength of this risk factor is not well established across diverse Hispanic populations.

METHODS: We investigated the associations among APOE genotype, dementia prevalence, and memory performance (immediate and delayed recall scores) in Caribbean Hispanics (CH), African Americans (AA), Hispanic Americans (HA) and non-Hispanic White Americans (NHW). Multivariable logistic regressions and negative binomial regressions were used to examine these associations by subsample.

RESULTS: Our final dataset included 13,516 participants (5198 men, 8318 women) across all subsamples, with a mean age of 74.8 years. Prevalence of APOE ε4 allele was similar in CHs, HAs, and NHWs (21.8\%-25.4\%), but was substantially higher in AAs (33.6\%; P~<~0.001). APOE ε4 carriers had higher dementia prevalence across all groups.

DISCUSSION: APOE ε4 was similarly associated with increased relative risk of dementia and lower memory performance in all subsamples.

}, keywords = {Aged, Alleles, Alzheimer disease, Apolipoprotein E4, Apolipoproteins E, Caribbean Region, Female, Genotype, Hispanic or Latino, Humans, Male}, issn = {1552-5279}, doi = {10.1002/alz.12699}, author = {Llibre-Guerra, Jorge J and Li, Jing and Qian, Yuting and Llibre-Rodriguez, Juan de Jes{\'u}s and Jim{\'e}nez-Vel{\'a}zquez, Ivonne Z and Acosta, Daisy and Salas, Aquiles and Llibre-Guerra, Juan Carlos and Valvuerdi, Adolfo and Harrati, Amal and Weiss, Jordan and Liu, Mao-Mei and Dow, William H} } @article {13684, title = {Dementia Attributable Healthcare Utilizations in the Caribbean versus United States.}, journal = {Journal of Alzheimers Disease: JAD}, volume = {96}, year = {2023}, pages = {801-811}, abstract = {

BACKGROUND: Despite the high burden of Alzheimer{\textquoteright}s disease and other dementias among the Hispanic population worldwide, little is known about how dementia affects healthcare utilizations among this population outside of the US, in particular among those in the Caribbean region.

OBJECTIVE: This study examines healthcare utilization associated with Alzheimer{\textquoteright}s disease and other dementias among older adults in the Caribbean as compared to the US.

METHODS: We conducted harmonized analyses of two population-based surveys, the 10/66 Dementia Group Research data collected in Dominican Republic, Cuba, and Puerto Rico, and the US-based Health and Retirement Study. We examined changes in hospital nights and physician visits in response to incident and ongoing dementias.

RESULTS: Incident dementia significantly increased the risk of hospitalization and number of hospital nights in both populations. Ongoing dementia increased the risk of hospitalization and hospital nights in the US, with imprecise estimates for the Caribbean. The number of physician visits was elevated in the US but not in the Caribbean.

CONCLUSIONS: The concentration of increased healthcare utilization on hospital care and among patients with incident dementia suggests an opportunity for improved outpatient management of new and existing dementia patients in the Caribbean.

}, keywords = {Aged, Alzheimer disease, Delivery of Health Care, ethnicity, Humans, Patient Acceptance of Health Care, Puerto Rico, United States}, issn = {1875-8908}, doi = {10.3233/JAD-230505}, author = {Li, Jing and Weiss, Jordan and Rajadhyaksha, Ashish and Acosta, Daisy and Harrati, Amal and Jim{\'e}nez Vel{\'a}zquez, Ivonne Z and Liu, Mao-Mei and Guerra, Jorge J Llibre and Rodriguez, Juan de Jes{\'u}s Llibre and Dow, William H} } @article {13686, title = {Dementia Attributable Healthcare Utilizations in the Caribbean versus United States.}, journal = {Journal of Alzheimers Disease: JAD}, volume = {96}, year = {2023}, pages = {801-811}, abstract = {

BACKGROUND: Despite the high burden of Alzheimer{\textquoteright}s disease and other dementias among the Hispanic population worldwide, little is known about how dementia affects healthcare utilizations among this population outside of the US, in particular among those in the Caribbean region.

OBJECTIVE: This study examines healthcare utilization associated with Alzheimer{\textquoteright}s disease and other dementias among older adults in the Caribbean as compared to the US.

METHODS: We conducted harmonized analyses of two population-based surveys, the 10/66 Dementia Group Research data collected in Dominican Republic, Cuba, and Puerto Rico, and the US-based Health and Retirement Study. We examined changes in hospital nights and physician visits in response to incident and ongoing dementias.

RESULTS: Incident dementia significantly increased the risk of hospitalization and number of hospital nights in both populations. Ongoing dementia increased the risk of hospitalization and hospital nights in the US, with imprecise estimates for the Caribbean. The number of physician visits was elevated in the US but not in the Caribbean.

CONCLUSIONS: The concentration of increased healthcare utilization on hospital care and among patients with incident dementia suggests an opportunity for improved outpatient management of new and existing dementia patients in the Caribbean.

}, keywords = {Aged, Alzheimer disease, Delivery of Health Care, ethnicity, Humans, Patient Acceptance of Health Care, Puerto Rico, United States}, issn = {1875-8908}, doi = {10.3233/JAD-230505}, author = {Li, Jing and Weiss, Jordan and Rajadhyaksha, Ashish and Acosta, Daisy} } @article {12674, title = {Management of Financial Assets by Older Adults With and Without Dementia or Other Cognitive Impairments.}, journal = {JAMA Network Open}, volume = {5}, year = {2022}, pages = {e2231436}, abstract = {Dementia and other cognitive impairments are prevalent among US older adults.1 Brain changes linked to cognitive impairment can lead to overconfidence, memory problems, and deficits in decision-making.2,3 These changes can have financial consequences, including missed bill payments, risky investment choices, and financial exploitation.3,4 To characterize the population at risk of cognitive impairment{\textendash}associated asset mismanagement, we assessed the extent to which older US adults with and without cognitive impairment manage their own money, including risky assets (eg, stocks and loans).}, keywords = {Cognitive Dysfunction, Dementia, Financial Statements}, issn = {2574-3805}, doi = {10.1001/jamanetworkopen.2022.31436}, author = {Li, Jing and Wang, Shuqi and Nicholas, Lauren Hersch} } @article {11843, title = {Associations between education and dementia in the Caribbean and the United States: An international comparison.}, journal = {Alzheimer{\textquoteright}s \& Dementia}, volume = {7}, year = {2021}, pages = {e12204}, abstract = {

Introduction: Despite high dementia prevalence in Hispanic populations globally, especially Caribbean Hispanics, no study has comparatively examined the association between education and dementia among Hispanics living in the Caribbean Islands and older adults in the United States.

Methods: We used data on 6107 respondents aged 65 and older in the baseline wave of the population-based and harmonized 10/66 survey from Cuba, the Dominican Republic, and Puerto Rico, collected between 2003 and 2008, and 11,032 respondents aged 65 and older from the U.S.-based Health and Retirement Study data in 2014, a total of 17,139 individuals. We estimated multivariable logistic regression models examining the association between education and dementia, adjusted for age, income, assets, and occupation. The models were estimated separately for the Caribbean population (pooled and by setting) and the U.S. population by race/ethnicity (Hispanic, Black, and White), followed by pooled models across all populations.

Results: In the Caribbean population, the relative risk of dementia among low versus high educated adults was 1.45 for women (95\% confidence interval [CI] 1.17, 1.74) and 1.92 (95\% CI 1.35, 2.49) for men, smaller compared to those in the United States, especially among non-Hispanic Whites (women: 2.78, 95\% CI 1.94, 3.61; men: 5.98, 95\% CI 4.02, 7.95).

Discussion: The differential associations between education and dementia across the Caribbean and US settings may be explained by greater disparities in social conditions in the United States compared to the Caribbean, such as access to health care, healthy behaviors, and social stressors, which serve as potentially important mediators.

}, keywords = {Caribbean, Dementia, Education, Hispanics, Sister studies}, issn = {2352-8737}, doi = {10.1002/trc2.12204}, author = {Li, Jing and Llibre-Guerra, Jorge J and Harrati, Amal and Weiss, Jordan and Jim{\'e}nez-Vel{\'a}zquez, Ivonne Z and Acosta, Daisy and Llibre-Rodriguez, Juan de Jes{\'u}s and Liu, Mao-Mei and William H Dow} } @article {11426, title = {Cognitive Impairment and Prevalence of Memory-Related Diagnoses among U.S. Older Adults}, number = {No 777}, year = {2021}, institution = { Global Labor Organization}, address = {Essen, Germany}, abstract = {Cognitive impairment creates significant challenges to health and well-being of the fast-growing aging population. Early recognition of cognitive impairment may confer important advantages, allowing for diagnosis and appropriate treatment, education, psychosocial support, and improved decision-making regarding life planning, health care, and financial matters. Yet the prevalence of memory-related diagnoses among older adults with early symptoms of cognitive impairment is unknown. Using 2000-2014 Health and Retirement Survey - Medicare linked data, we leveraged within-individual variation in a longitudinal cohort design to examine the relationship between incident cognitive impairment and receipt of diagnosis among American older adults. Receipt of a memory-related diagnosis was determined by ICD-9-CM codes. Incident cognitive impairment was assessed using the modified Telephone Interview of Cognitive Status (TICS). We found overall low prevalence of early memory-related diagnosis, or high rate of underdiagnosis, among older adults showing symptoms of cognitive impairment, especially among non-whites and socioeconomically disadvantaged subgroups. Our findings call for targeted interventions to improve the rate of early diagnosis, especially among vulnerable populations. }, keywords = {cognitive aging, cognitive impairment, Dementia, Medicare, memory-related diagnosis}, url = {https://www.econstor.eu/bitstream/10419/229436/1/GLO-DP-0777.pdf}, author = {Qian, Yuting and Chen, Xi and Tang, Diwen and Amy Kelley and Li, Jing} }