P3‐114: Functional limitations and healthcare resource utilization for individuals with cognitive impairment without dementia: Findings from a u.s. population‐based survey

While functional and economic burden of dementia is well-documented, little is known regarding the burden of earlier stages like mild cognitive impairment and cognitive impairment with no dementia (CIND). This study compared functional limitations and healthcare resource use for respondents with CIND enrolled in 2000-2010 in the Health and Retirement Study (HRS), a longitudinal household survey of US adults aged ≥50, with those of similar respondents with no cognitive impairment (CI). Cognitive status was determined using the 27-point Telephone Interview for Cognitive Status (TICS) scale for self-respondents (no CI: score≥12, CIND: 7-11, dementia: 0-6), and an 11-point scale for those requiring proxy respondents (no CI: 0-2, CIND: 3-5, dementia: score≥6). Only respondents with stable or progressive CI after the first (index) wave with CIND were included. Respondents never exhibiting CI were identified as potential controls (index wave selected at random). The cohorts were matched using propensity score-based optimal matching to account for differences in demographics and history of stroke. Statistical significance of differences in respondent characteristics, functional limitations, and resource use in index wave was assessed using generalized linear regression models. Rates of progression to dementia among CIND respondents were estimated using Kaplan-Meier survival analyses. All analyses accounted for complex survey design. The analytic sample included 503 CIND and 8,170 no CI respondents. Before matching, CIND respondents were significantly older, more often female, less educated, less frequently Caucasian, and more likely to report each of the 8 comorbidities assessed than no CI respondents. Postmatch cohorts (both n=494) were similar except for significantly higher rates of diabetes and emotional, nervous, and psychiatric problems among CIND respondents (Table 1). CIND respondents also had significantly more functional limitations (difficulty with ≥1 ADL: 24% vs. 15%, IADL: 20% vs. 11%) and hospital stays (37% vs. 27%) than their matched counterparts (Table 2). 17% of CIND respondents progressed to dementia within 2 years and 75% did so over the full observation period (median time: ∼6 years; Figure 1). Rates of progression to dementia among CIND respondents For respondents with gaps, the last observed cognitive status was carried forward. A gap was defined as a wave after the index wave with missing cognitive assessment data, but followed by at least one wave with valid cognitive assessment data. Respondents were censored at the last wave with valid cognitive assessment data. Analyses incorporate person-level weights (provided by the HRS) from 2004. Respondents without a positive weight in 2004 were excluded from the analyses. Even prior to dementia onset, CI is associated with substantially increased likelihood of functional limitations and greater healthcare resource use, suggesting considerable burden of CIND.