Observation of Patient and Caregiver Burden Associated with Early Alzheimer's Disease in the United States: Design and Baseline Findings of the GERAS-US Cohort Study1

Rebecca L Robinson, Dorene M Rentz, Valerie Bruemmer, Jeffrey Scott Andrews, Anthony Zagar, Yongin Kim, Ronald L Schwartz, Wenyu Ye, Howard M Fillit, Rebecca L Robinson, Dorene M Rentz, Valerie Bruemmer, Jeffrey Scott Andrews, Anthony Zagar, Yongin Kim, Ronald L Schwartz, Wenyu Ye, Howard M Fillit

Abstract

Background: Alzheimer's disease (AD) is one of the costliest diseases in the United States.

Objective: To describe aspects of real-world patient and caregiver burden in patients with clinician-diagnosed early AD, including mild cognitive impairment (MCI) and mild dementia (MILD) due to AD.

Methods: Cross-sectional assessment of GERAS-US, a 36-month cohort study of patients seeking care for early AD. Eligible patients were categorized based on study-defined categories of MCI and MILD and by amyloid positivity [+] or negativity [-] within each severity cohort. Demographic characteristics, health-related outcomes, medical history, and caregiver burden by amyloid status are described.

Results: Of 1,198 patients with clinician-diagnosed early AD, 52% were amyloid[+]. For patients in both cohorts, amyloid[-] was more likely to occur in those with: delayed time to an AD-related diagnosis, higher rates of depression, poorer Bath Assessment of Subjective Quality of Life in Dementia scores, and Hispanic/Latino ethnicity (all p < 0.05). MILD[-] patients (versus MILD[+]) were more medically complex with greater rates of depression (55.7% versus 40.4%), sleep disorders (34.3% versus 26.5%), and obstructive pulmonary disease (11.8% versus 6.6%); and higher caregiver burden (Zarit Burden Interview) (all p < 0.05). MILD[+] patients had lower function according to the Functional Activities Questionnaire (p < 0.001), yet self-assessment of cognitive complaints across multiple measures did not differ by amyloid status in either severity cohort.

Conclusions: Considerable patient and caregiver burden was observed in patients seeking care for memory concerns. Different patterns emerged when both disease severity and amyloid status were evaluated underscoring the need for further diagnostic assessment and care for patients.Study Registry:H8A-US-B004; ClinicalTrials.gov: NCT02951598.

Keywords: Alzheimer’s disease; amyloid; burden of illness; florbetapir F18; mild Alzheimer’s dementia; mild cognitive impairment.

Conflict of interest statement

Authors’ disclosures available online (https://www.j-alz.com/manuscript-disclosures/19-0430r2).

Figures

Fig.1
Fig.1
Four-Stage Approach of Study Disease Classification. aPatients falling outside of these ranges were classified as MCI or MILD based on their current clinician-reported diagnosis. If patients were missing a diagnosis they were excluded from the analyses. FAQ, Functional Activities Questionnaire; MCI, mild cognitive impairment; MILD, mild dementia; MMSE, Mini-Mental State Examination; [+], amyloid positive; [–], amyloid negative.
Fig.2
Fig.2
Patient Attrition at Baseline. MCI, mild cognitive impairment; MILD, mild dementia; MMSE, Mini-Mental State Examination; PET, positron emission tomography; +, amyloid positive; –, amyloid negative.

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