Formal and informal healthcare utilization in MCI and mild dementia due to AD: Cross‐sectional and longitudinal analyses of RUD‐Lite data from the Tauriel Study

Abstract

AbstractBackgroundThe Resource Utilization in Dementia‐Lite (RUD‐Lite) scale measures both formal healthcare utilization and informal caregiver time required by individuals with cognitive impairment. The RUD‐Lite has been incorporated into multiple observational and interventional studies of participants with Alzheimer’s disease (AD) dementia of varying severity. However, RUD‐Lite data for earlier stages of AD such as mild cognitive impairment (MCI) is limited and is primarily from observational studies. As healthcare utilization may differ between participants in observational versus interventional studies, we analyzed data from the Tauriel study of semorinemab in MCI and mild dementia due to AD (NCT03289143).MethodsWe performed cross‐sectional and longitudinal RUD‐Lite comparisons between MCI (n = 160) and mild dementia (n = 288) cohorts of the Tauriel study, exploring formal healthcare usage (hospital admissions, emergency department visits, outpatient visits, and ancillary services) and informal caregiver time for assistance with basic (BADLs) and instrumental (IADLs) activities of daily living and participant supervision. Both unadjusted and adjusted (for baseline usage, age, sex) analyses were performed on longitudinal data.ResultsBaseline cross‐sectional analyses (Table 1) indicated that mild dementia participants required significantly greater caregiver time for assistance with IADLs than MCI participants. Other formal and informal healthcare utilization indices did not differ between groups. Unadjusted longitudinal analyses across 18 months (Figure 1) revealed significant increases in informal caregiver assistance with BADLs (MCI:+40%, mild dementia:+231%), IADLs (MCI:+31%, mild dementia:+34%), and supervision (mild dementia:+219%) and in ancillary service usage (mild dementia:+345%). Adjusted longitudinal analyses (Figure 2) revealed significantly greater increases in mild dementia versus MCI for assistance time with BADLs, IADLs, and supervision.ConclusionInformal caregiver time spent providing assistance in early AD increases with disease severity and longitudinal changes are detectable in MCI over 18 months. Formal healthcare utilization indices were less sensitive to disease progression. While the RUD‐Lite results from this interventional study are consistent with observational data from analogous populations, less caregiver assistance time was reported in our cohort. When using RUD‐Lite outcomes in future early AD studies, investigators may need to account for their participant population (e.g., observational versus interventional) in their study design.