Estimating the prevalence of mild cognitive impairment from clinical notes in U.S. Veterans

Abstract

AbstractBackgroundIndividuals with mild cognitive impairment (MCI), a noticeable decline in cognitive abilities, are at increased risk of developing Alzheimer’s disease (AD) or other dementia. Risk factors for dementia, such as obesity, stroke, depression are highly prevalent among U.S. veterans We report on the trends in the prevalence of MCI using clinical notes over the past 5 years in the Veteran Affairs, the largest integrated healthcare system in the U.S.MethodPrevalent cases of MCI were identified from VA clinical notes for all Veterans aged 50 years and older in VA care from fiscal years (FYs) 2015‐19. VA clinical notes are maintained in searchable text integration utility files (TIU) available in the VA Corporate Data Warehouse (CDW). Pharmacy clinical notes were excluded. “Mild cognitive impairment” keyword was searched in clinical notes to identify patients with MCI. We validated the keyword “mild cognitive impairment” in 199 clinical notes. The positive predictive value for this validation was approximately 91%. For each FY, age and sex adjusted rates directly standardized to the 2010 U.S. Census general population were estimated.ResultA total of 308,930 prevalent cases of MCI were identified from VA clinical notes from FYs 2015‐19. Standardized prevalence rates for MCI increased steeply, with prevalence of 0.9% in FY 2015, increasing to 1.31% in FY 2019. Standardized age adjusted MCI prevalence rates also increased sharply for male (0.77% in FY 2015 to 1.10% in FY 2019) and female veterans (1.01% in FY 2015 to 1.50% in FY 2019) with rates higher for females than males for each FY.ConclusionWe observed recent trends of increasing prevalence rates for MCI among veterans identified from VA clinical notes. Considering the increased risk of dementia among individuals with MCI, our study finding of increasing prevalence of MCI among veterans highlights the critical need for effective interventions and treatment to target veterans with MCI.