Additionally, because of the younger age at inception with early-onset ADRDs, most patients are still in the workforce and continue to have notable family and social responsibilities. 3 - 6 As a result, patients with early-onset ADRDs may experience rapid cognitive decline and become highly dependent on unprepared family caregivers. 2 Early-onset ADRDs are associated with a more aggressive clinical course, with accelerated cognitive and functional declines compared with later-onset ADRDs. While most patients with ADRDs are older than age 65 years, 1 approximately 6% have early-onset ADRDs between ages 30 and 65 years. These findings suggest that efforts, such as clinician education or teleconsultative guidance to PCPs, may be needed to enhance access to specialist services in rural areas.Īlzheimer disease and related dementias (ADRDs) are debilitating conditions that cause loss of memory, cognition, and independent functioning. However, new patients in rural areas with early-onset ADRDs were more likely to have only PCP visits for diagnosis and symptom management compared with those in urban areas (OR, 1.40 95% CI, 1.19-1.66).Ĭonclusions and Relevance This study found that new patients with early-onset ADRDs in rural areas were less likely to receive neuropsychological testing or visit psychologists but more likely to be diagnosed and treated exclusively by PCPs compared with those in urban areas. However, new patients in rural areas were less likely to receive neuropsychological testing (odds ratio, 0.83 95% CI, 0.70-0.98) or visit a psychologist (OR, 0.72 95% CI, 0.60-0.85) compared with patients in urban areas. There were no statistically significant differences between new patients with early-onset ADRDs in rural vs urban areas in the use of psychological assessments, imaging studies, or visits to neurologists or psychiatrists. Results Among 71 799 patients with early-onset ADRD (mean age, 56.34 years 39 231 women ), 8430 individuals had new early-onset ADRDs (mean age, 55.94 years 16 512 women ). Access to different clinicians on the index date or 90 days or less after the index date was also collected, including visits to primary care physicians and nurse practitioners (PCPs) and specialty visits to psychologists, neurologists, and psychiatrists.

Main Outcomes and Measures Among patients with new, early-onset ADRDs, use of psychological assessment and neuropsychological testing performed at the initial diagnosis (index date) or 90 days or less after the index date and use of brain imaging during the 180 days before the index date were collected. Data were analyzed from February 2021 to March 2022.

The likelihood of receiving diagnostic and symptom management services was estimated, with adjustment for individual-level variables associated with health care use. Included patients were those with early-onset ADRDs aged 40 to 64 years, including new patients, defined as those with no claims of ADRDs for 36 months before the first ADRD diagnosis. Objectives To examine rural vs urban differences in diagnostic and symptom management service use among patients with early-onset ADRDs.ĭesign, Setting, and Participants This cross-sectional study was conducted using commercial claims from 2012 to 2017. Importance Limited access to appropriate specialists and testing may be associated with delayed diagnosis and symptom management for patients with early-onset Alzheimer disease and related dementias (ADRDs).

Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.

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