Alzheimer’s Disease Stage Transitions Among United States Veterans

Article type: Research Article

Authors: Morin, Peter^a | Aguilar, Byron J.^b | Li, Xuyang^b | Chen, Jinying^c | Berlowitz, Dan^d | Zhang, Raymond^e | Tahami Monfared, Amir Abbas^{e; f} | Zhang, Quanwu^e | Xia, Weiming^{b; g; h; *}

Affiliations: [a] Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA | [b] Geriatric Research Education and Clinical Center, Bedford VA Healthcare System, Bedford, MA, USA | [c] Department of Preventive Medicine and Epidemiology, Data Science Core, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA | [d] Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, USA | [e] Alzheimer’s Disease and Brain Health, EisaiInc., Nutley, NJ, USA | [f] Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada | [g] Department of Pharmacology, Physiology and Biophysics, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA | [h] Department of Biological Sciences, Kennedy College of Science, University of Massachusetts Lowell, Lowell, MA, USA

Correspondence: [*] Correspondence to: Weiming Xia, PhD, Geriatric Research Education and Clinical Center, Bedford VA Healthcare System, 200 Springs Road, Bedford, MA 01730, USA. Tel.: +1 781 824 1077; Fax: +1 781 687 3463; E-mail: weiming.xia@va.gov.

Abstract: Background: Alzheimer’s disease (AD) and related dementias are progressive neurological disorders with stage-specific clinical features and challenges. An important knowledge gap is the “window of time” within which patients transition from mild cognitive impairment or mild AD to moderate or severe AD. Better characterization/establishment of transition times would help clinicians initiating treatments, including anti-amyloid therapy. Objective: To describe cognitive test score-based AD stage transitions in Veterans with AD in the US Veterans Affairs Healthcare System (VAHS). Methods: This retrospective analysis (2010–2019) identified Veterans with AD from the VAHS Electronic Health Record (EHR) notes. AD stage was based on Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), or Saint Louis University Mental Status (SLUMS) Examination scores in the EHR. Results: We identified 296,519 Veterans with cognitive test-based AD staging. Over the 10-year study, the proportion of veterans with MMSE scores declined from 24.9% to 9.5% while those with SLUMS rose from 9.0% to 17.8%; and MoCA rose from 5.0% to 25.4%. The average forward transition times between each stage were approximately 2–4 years, whether assessed by MMSE, MoCA, or SLUMS. Conclusion:The average transition time for cognitive test-based assessments of initial cognitive decline, early-stage AD, and moderate/severe AD in the VAHS is 2–4 years. In view of the short window for introducing disease-modifying therapy and the significant benefits of early treatment of AD, our data suggest a critical need for treatment guidelines in the management of AD.

Keywords: Alzheimer’s disease, amyloid, anti-amyloid therapy, cognitive test, dementia, mild cognitive impairment, mini-mental state examination, montreal cognitive assessment, saint louis university mental status examination, veterans

DOI: 10.3233/JAD-230850

Journal: Journal of Alzheimer's Disease, vol. 97, no. 2, pp. 687-695, 2024